Korean J Radiol.  2013 Oct;14(5):805-809. 10.3348/kjr.2013.14.5.805.

Combination Therapy of Temporary Tracheal Stenting and Radiofrequency Ablation for Multinodular Thyroid Goiter with Airway Compression

• Shin JH
• Baek JH
• Oh YM
• Ha EJ
• Lee JH

• KMID: 1711438
• DOI: http://doi.org/10.3348/kjr.2013.14.5.805

Abstract

We report a case of multinodular thyroid goiter in an 80-year-old man who successfully underwent tracheal stent placement for respiratory distress caused by the thyroid goiter and following two radiofrequency (RF) ablation sessions performed for thyroid volume reduction. This sequential treatment allowed elective stent removals four weeks after the second RF ablation session because the thyroid volume had been progressively reduced. Combination therapy of temporary airway stenting and RF ablation for the treatment of thyroid goiter has two advantages, i.e., immediate reliefs of dyspnea with airway stenting and reductions of the thyroid volume with RF ablation, and thus, allowing symptom reliefs even after the stent removals.

Keyword

Airway stenting; Radiofrequency ablation; Thyroid goiter

MeSH Terms

Aged, 80 and over
Airway Obstruction/etiology/radiography/*therapy
Catheter Ablation/*methods
Goiter, Nodular/complications/radiography/*therapy
Humans
Male
*Stents
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Tracheal stenting and radiofrequency ablation for thyroid goiter.A. At time of patient's admission, photograph (A) shows diffuse swelling on neck. Axial CT scan (B) shows stenotic tracheal lumen (arrows) caused by enlarged thyroid lobes with internal nodules and calcifications. C, D. Placement of retrievable, self-expandable and silicone-covered with barbed metallic stent to relieve dyspnea. Radiograph (C) obtained after contrast injection through 5 Fr catheter shows stenotic tracheal lumen (arrows). Radiograph (D) obtained immediately after stent placement shows well-expanded stent. Two radiofrequency ablation sessions were performed one and six weeks, respectively, following stent placement (not shown). E-G. CT scan (E) and photograph (F) obtained four weeks following second radiofrequency ablation session, shows reduction of thyroid volume. Stent was removed by using retrievable hook (arrow) (G). H. Follow-up CT scan obtained five weeks following stent removal shows stable maintenance of reduced thyroid volume and slightly widened tracheal lumen (arrows) as compared with initial CT scans obtained before stent placement.

Reference

1. Ríos A, Rodríguez JM, Canteras M, Galindo PJ, Tebar FJ, Parrilla P. Surgical management of multinodular goiter with compression symptoms. Arch Surg. 2005; 140:49–53. PMID: 15655205.

2. Kim WK, Shin JH, Kim JH, Song JW, Song HY. Management of tracheal obstruction caused by benign or malignant thyroid disease using covered retrievable self-expandable nitinol stents. Acta Radiol. 2010; 51:768–774. PMID: 20707660.

3. Noppen M, Poppe K, D'Haese J, Meysman M, Velkeniers B, Vincken W. Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease. Chest. 2004; 125:723–730. PMID: 14769757.

4. Schmidt B, Olze H, Borges AC, John M, Liebers U, Kaschke O, et al. Endotracheal balloon dilatation and stent implantation in benign stenoses. Ann Thorac Surg. 2001; 71:1630–1634. PMID: 11383812.

5. Noppen M, Meysman M, Dhondt E, Gepts L, Velkeniers B, Vanhaelst L, et al. Upper airway obstruction due to inoperable intrathoracic goitre treated by tracheal endoprosthesis. Thorax. 1994; 49:1034–1036. PMID: 7974300.

6. Kim JH, Shin JH, Song HY, Shim TS, Yoon CJ, Ko GY. Benign tracheobronchial strictures: long-term results and factors affecting airway patency after temporary stent placement. AJR Am J Roentgenol. 2007; 188:1033–1038. PMID: 17377041.

7. Shin JH, Kim SW, Shim TS, Jung GS, Kim TH, Ko GY, et al. Malignant tracheobronchial strictures: palliation with covered retrievable expandable nitinol stent. J Vasc Interv Radiol. 2003; 14:1525–1534. PMID: 14654487.

8. Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol. 2011; 12:525–540. PMID: 21927553.

9. Na DG, Lee JH, Jung SL, Kim JH, Sung JY, Shin JH, et al. Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations. Korean J Radiol. 2012; 13:117–125. PMID: 22438678.

10. Ha EJ, Baek JH, Lee JH. The efficacy and complications of radiofrequency ablation of thyroid nodules. Curr Opin Endocrinol Diabetes Obes. 2011; 18:310–314. PMID: 21841482.

11. Jeong WK, Baek JH, Rhim H, Kim YS, Kwak MS, Jeong HJ, et al. Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients. Eur Radiol. 2008; 18:1244–1250. PMID: 18286289.

12. Baek JH, Kim YS, Lee D, Huh JY, Lee JH. Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol. 2010; 194:1137–1142. PMID: 20308523.

13. Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM. Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid. 2010; 20:1253–1261. PMID: 20929405.

14. Shin JH, Song HY, Kim JH, Kim SB, Lee GH, Park SI, et al. Comparison of temporary and permanent stent placement with concurrent radiation therapy in patients with esophageal carcinoma. J Vasc Interv Radiol. 2005; 16:67–74. PMID: 15640412.

15. Kim JH, Shin JH, Song HY, Ohm JY, Lee JM, Lee DH, et al. Palliative treatment of inoperable malignant tracheobronchial obstruction: temporary stenting combined with radiation therapy and/or chemotherapy. AJR Am J Roentgenol. 2009; 193:W38–W42. PMID: 19542381.

16. Spiezia S, Garberoglio R, Milone F, Ramundo V, Caiazzo C, Assanti AP, et al. Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid. 2009; 19:219–225. PMID: 19265492.

17. Kim HY, Ryu WS, Woo SU, Son GS, Lee ES, Lee JB, et al. Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation. J Cancer Res Ther. 2010; 6:310–312. PMID: 21119260.