In cross sectional surveys worldwide, the prevalence of multinodular goiter has grown in the adult population, and the women to men ratio is of at least 4:1 . In the Whickham survey, 16% of the cohort had palpable diffuse or multinodular goiters (MG) . The natural history of multinodular goiter varies, goiter growth and function being difficult to predict in patients; 20% (or more) of the solid nodules appear to increase in size over time. . The therapeutic strategies for euthyroid patients are clinical surveillance, L-Thyroxine (L-T4) suppression therapy, percutaneous ethanol injection, and surgery, which is indicated in the following clinical situations: progressive growth of the entire goiter or of individual nodules; compression of the trachea, esophagus, recurrent laryngeal nerve or cervical veins; and significant aesthetic disfigurement. L-T4 therapy has little or no effect on nodule size .
In 2002 Døssing H et al.  and in 2004 Pacella CM et al  introduced ultrasound-guided laser photocoagulation for the treatment of benign thyroid nodules. Our group in Perugia, after a training with Doctors C. Pacella and E. Papini, started the procedure in 2005. The first results with ultrasound-guided laser photocoagulation by our group have been published in 2006 and were very promising . For this reason, we implemented the technology and, actually, we are using a new generation Laser,a 1064nm continuous-wave neodymium yttrium-aluminum-garnet laser (Smart 1064, Elesta, Florence, Italy) combined with ultrasound guidance using a multifrequency probe (8-13MHz) (Esaote). In a recent study, we compared in terms of efficacy and safety different amounts of energy delivered for percutaneous laser thermalnodule ablation .
The percutaneous laser thermal ablation of thyroid nodules is a viablealternative to traditional surgery since it is less invasive and, therefore, incurs fewer complications (possibly mild fever and local pain for a few hours). At present,on a case series of 500 nodules treated, our average rate of reduction of volume size of benign thyroid nodules is 62% (12 months after a single treatment) and recurrence or unsuccessful rates are less than 5%. The treatment is almost painlessand does not require sedation or anesthesia (see in the section “dicono di noi” a letter reporting the experience of a patient coming from Sidney, Australia).
It is possible for patients living outside of Italy to undergo to laser thermal ablationof thyroid nodules with anhalf day stay in the Medical Center BIOS ( www.biosterni.com/), Via Linda Malnati, 15/A – 05100 Terni.The medical center is about a 80-minute drive from the Fiumicino Airport in Rome. Usually patients are treated in the morning and go home after 3-4 hours. The costs of the treatment is 2000 euro, all included. Before the laser treatment it is necessary to have two recent cytological exams of the nodule which confirm that it is a benign tumor. For further information, please contact firstname.lastname@example.org.
Centro medico – BIOS TERNI
www.biosterni.com | Via Linda Malnati, 15/A – 05100 Terni
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Outcomes and Risk Factors for Complications of Laser Ablation for Thyroid Nodules: A Multicenter Study on 1531 Patients.J ClinEndocrinolMetab. 2015 Oct;100(10):3903-10. doi: 10.1210/jc.2015-1964. Epub 2015 Aug 14.
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Thyroid nodule morphology affects the efficacy of ultrasound-guided interstitial laser ablation: a nested case-control study.Int J Hyperthermia. 2014 Nov;30(7):486-9. doi: 10.3109/02656736.2014.963701. Epub 2014 Oct 7.
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13) Giovanni Gambelunghe, Elisa Stefanetti, Renato Colella, Massimo Monacelli, Nicola Avenia & Pierpaolo De Feo A single session of laser ablation for toxic thyroid nodules: three-year follow-up results International Journal of Hyperthermia Vol. 0, Iss. 0, 2018 https://doi.org/10.1080/02656736.2018.1437931