Efficacy and safety of microwave ablation for benign thyroid nodules: a Meta-analysis / 中华内分泌外科杂志

Objective To evaluate the efficacy and safety of microwave ablation in treatment of benign thyroid nodules by a meta-analysis.Methods A database searching was performed on the Pubmed (Medline),CochraneLibrary,Embase,China National Knowledge Infrastructure(CNKI),wanfang database,biomedical literature database (Sinomed) and VIP database.Randomized controlled studies of microwave ablation for benign thyroid nodules were selected and analyzed.Documents were screened in accordance with the inclusion and exclusion criteria.Data analysis was performed by using Revman5.3 software.Results Twelve studies matched the selection criteria,which involved 1221 patients.The results showed that microwave ablation was superior to traditional surgery in the following aspects:the time of operation [MD=-50.78,95％ CI=(-58.20,-43.36),P＜0.01,I2=97％],the amount of blood loss[MD=-23.21,95％ CI=(-27.18,-19.23),P＜0.01,I2=99％],the time of hospitalization [MD=-3.39,95％ CI=(-4.08,-2.71),P＜0.01,I2=98％],the changes of CRP,IL-6,TNF-alpha in 12 h,24 h or 48 h after operation,the changes in the level of FT3 and FT4 in 1 month and 3 months after operation,and the incidence of surgical complications [MD=0.20,95％ CI=(0.13,0.32),P＜0.01,I2=0％],P＜0.01 respectively.Conclusions Microwave ablation has many advantages,such as small trauma,beautiful appearance,quick recovery,little influence on thyroid function and fewer operative complications.It is safe and reliable in clinical application.

Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation

Background: Thyroid gland is afflicted by various pathologies ranging from diffuse enlargement (goitre) to nodular lesions, thyroiditis, and malignancy. Presently high resolution ultrasound with color Doppler is the primary imaging modality of choice in morphological evaluation of thyroid gland. It is used to define the nature of the lesion, whether solid or cystic, to differentiate thyroid from extra thyroidal masses, to assess the size of nodule in patients who are under observation or therapy, to monitor patient who are at increased risk of thyroid malignancy especially those with radiation exposure or having a family history, to detect recurrence of thyroid malignancy after surgery and in interventional procedure like guiding in FNAC. Materials and methods: Study was carried out using standard 5-12 MHz frequency probe with grey scale and color Doppler spectrum to evaluate and analysis of different thyroid nodules and taking Ultrasound guided fine needle aspiration cytology and correlate histopathologically. Results: Majority of patients belonged to middle age group between 21-60 years with mean age of 38.2 years. Colloid goitre was most common presentation on ultrasound and it showed wide spectrum of appearance, majority being nodular with anechoic echotexture. Malignant lesions of thyroid were usually hypoechoic, though all hypoechoic lesions were not malignant. (Sensitivity of 75%, specificity of 81.48%, PPV of 37.5% and NPV 95.65%). The most sensitive sign for picking up malignancy on USG were Intralesional vascularity; absent halo sign and regional lymph node Siddharth Zala, C. Raychaudhuri. Evaluation of thyroid lesions with gray scale ultrasound/ color doppler imaging and fine needle aspiration cytology correlation. IAIM, 2019; 6(4): 86-91. Page 87 involvement (sensitivity of 100%) the most specific signs were invasion of adjacent tissue (specificity of 92.59%), Lymphadenopathy (85.18%) and hypoechotexture (81.48%). A combination of signs aid in prediction of malignancy and in guidance for site of FNAC. The most useful combination of sign proved to be Invasion to adjacent tissue, Lymphadenopathy, absent halo, hypoechogenicity, microcalcification and Intralesional vascularity on color flow imaging. Conclusion: The ultrasonographic findings in thyroiditis were usually hetroechogenicity and coarse calcification with diffuse vascularity on color flow imaging. The addition of color flow imaging to gray scale ultrasound had increased the overall sensitivity for diagnosis of thyroiditis (96.87%) and was also highly specific (89.70%)

Dynamic histopathological changes of thyroid nodule after microwave ablation and its clinical significance / 第二军医大学学报

Objective: To investigate the changes of tissue structure in the ablation area after microwave ablation of thyroid nodules and to identify the appropriate time for pathological evaluation of the ablation area. Methods: From January 2017 to December 2018, a total of 69 core-needle biopsy tissue samples from the ablation area of thyroid nodules in 60 patients were investigated histologically using H-E and immunohistochemical staining. The samples were taken after microwave ablation at different stages and from different areas. Cellular morphology and tissue structure as well as thyroid transcription factor 1 (TTF1) in the tissues from the central zone and marginal zone of ablation area were observed immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. Results: Successful biopsies were achieved in 69, 12, 19, 25 and 13 ablation areas immediately, 1 month, 3 months, 6 months and 12 months after microwave ablation. There was no necrosis but only coagulated degeneration in both the central zone and marginal zone of the 69 (100.00%) ablation areas immediately after microwave ablation. At 1 month after microwave ablation, 9 (75.00%) samples of central zone and 9 (75.00%) samples of marginal zone showed complete necrosis. At 3 months, 16 (84.21%) samples of central zone and 15 (78.95%) samples of marginal zone showed complete necrosis. At 6 and 12 months, all (100.00%) samples of central zone and marginal zone became necrotic completely. Conclusion: The histopathologic feature of thyroid nodules after microwave ablation varies with time. There is only coagulated degeneration in the freshly ablated thyroid tissue, and no necrosis is found. Necrosis occurs and progresses to the whole ablation area in all patients. It suggests that the reliable therapeutic effect of microwave ablation on thyroid nodules is due to complete necrocytosis. Necrosis occurs in all the ablation area at 6 months after microwave ablation, indicating the 6th month is an appropriate time for pathological evaluation of the ablation area.

Quality of Life in Patients Treated with Percutaneous Laser Ablation for Non-Functioning Benign Thyroid Nodules: A Prospective Single-Center Study

OBJECTIVE: While many studies have reported that laser ablation (LA) for benign non-fuctioning thyroid nodules is efficacious in reducing nodular volume and neck symptoms, none have described changes in quality of life (QoL). The purpose of this study was to report post-LA changes in QoL in our cohort of patients. MATERIALS AND METHODS: Fourteen patients with benign thyroid nodules were involved in a prospective, single-center study and underwent a single session of LA. We evaluated the following: changes in nodule volume, thyroid function, and autoimmunity; adverse events during and after LA; changes in neck discomfort by means of a visual analogic scale (VAS) at one week and 1, 3, 6, and 12 months; and changes in QoL through the 13-scale Thyroid-specific Patient Reported Outcome (ThyPRO) questionnaire at 1, 3, 6, and 12 months. ThyPRO is a validated questionnaire for thyroid diseases, which consists of 13 scales with multiple-choice answers. They investigate several aspects of life that may be impaired by goiter-related compression symptoms, by esthetic alterations and by hypo- or hyperthyroidism. RESULTS: Nodule volume decrease was −37 ± 23%, −55 ± 22%, −53 ± 25%, −58 ± 25% (p < 0.01 vs. baseline) at the first, third, sixth, and twelfth month, respectively. No hypothyroidism or positivization of autoimmunity was observed. There were no major complications during or after LA. After LA, VAS scores improved significantly from 1 week onwards in 100% of patients, while a significant improvement was seen in the goiter symptoms score after one month, and in the general score and mean values of ThyPRO after six months. Scores on the other ThyPRO scales did not change significantly. CONCLUSION: Laser ablation is safe and effective in reducing nodule volume and neck symptoms; this is confirmed by improvements in the goiter scale, general score, and mean values of ThyPRO and in the VAS score.

The effect and influencing factors of percutaneous radiofrequency ablation for the treatment of benign thyroid nodules / 中华医学超声杂志（电子版）

Objective To explore the curative effect and influencing factors of percutaneous radiofrequency ablation(PRFA)for benign thyroid nodules in order to improve the effect of thyroid benign nodule ablation treatment.Methods The study included 482 benign thyroid nodules.The largest diameter of benign thyroid nodules ranges from 0.7 to 9.2 cm.Two hundred and fifty-eight nodules were solid nodules,224 nodules were cystic-solid nodules,and 96 thyroid nodules combined with the background of Hashimoto's thyroiditis.The patients of this study included 356 females and 126 males,the ages of the study population ranged from 14 to 82 years old.In order to observe the local pain,swelling,skin infection,hoarseness and other complications of the thyroid nodules with PRFA,we conducted conventional ultrasound and contrast-enhanced ultrasound immediately and followed up in 1,3,6,12,18 and 24 months after the treatment.Besides,the nodule volume reduction ratio was calculated,and the effects of gender,age,nodule size,cystic proportion,and the background of Hashimoto's thyroiditis on the treatment were analyzed.Results The volume of benign thyroid nodules after the PRFA treatment was significantly reduced after 1,3,6,12,18,24 months,and their nodule volume reduction ratio(VRR)was(51.2±5.7)%(1 months),(69.7±4.3)%(3 months),(84.6±3.7)%(6 months),(89.3±2.9)%(12 months),(93.7±1.6)%(18 months)and(94.9±1.4)%(24 months),respectively.The thyroid nodules were divided into 3 groups according to the cystic portion,significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(F=66.858,69.101,19.410,49.559,146.653 and 309.950 respectively,all P＜0.001),the more cystic portion was,the faster the lesion shrinked.The nodules with the cystic portion ＜ 20%were grouped according to the maximum diameter(≤3 cm/＞3 cm),and the background of Hashimoto's disease; and significant differences were found in the volume reduction rate at 1,3,6,12,18 and 24 months after PRFA(the t values for different size groups were 9.710,8.925,9.899,12.734,17.226 and 42.580,respectively,the t values for whether there is a background of Hashimoto's disease were 66.858,69.101,19.410,49.559,146.653,309.950,respectively,all P ＜ 0.001).The VRR of nodules of which the maximum diameter ≤ 3 cm,or without Hashimoto's thyroiditis was larger after radiofrequency ablation.The nodules of which the maximum diameter≤3 cm and with the cystic portion ＜20%were grouped according to different genders(male or female)and different ages(≤40 or＞40 years old),and the mean VRR of the nodules between different gender and age groups are not significantly different(P＞0.05).Conclusions Ultrasound guided PRFA is a safe and effective minimally invasive therapy for benign thyroid nodules.

Application Value of Total Membrane Dissection in Endoscopic Thyroidectomy / 中国微创外科杂志

Objective To study the application value of endoscopic thyroidectomy via total membrane dissection. Methods One hundred and sixteen patients with benign thyroid nodules were given axillo-breast approach endoscopic thyroidectomy via total membrane dissection from January 2014 to December 2016. Results Endoscopic thyroidectomy was completed in all the patients without conversion to open surgery.The operation time was 45-125 min[mean,(65.6 ±36.7)min],the blood loss was 10-220 ml[mean,(43.2 ±22.7)ml],the postoperative drainage volume was 25-305 ml[mean,(95.3 ±53.8)ml], the postoperative drainage time was 2-4 d[mean,(2.3 ±0.7)d)],and the length of hospital stay was 3-6 d[mean,(4.1 ±1.1)d].Short-term twitch occurred in 1 case and seroma occurred in 2 cases.No other complications such as hoarseness,bucking or asphyxia occurred in this series. Conclusion Endoscopic thyroidectomy via total membrane dissection can effectively avoid the injury of recurrent laryngeal nerve and parathyroid gland.

Innovative Techniques for Image-Guided Ablation of Benign Thyroid Nodules: Combined Ethanol and Radiofrequency Ablation

In the treatment of benign thyroid nodules, ethanol ablation (EA), and radiofrequency ablation (RFA) have been suggested for cystic and solid thyroid nodules, respectively. Although combining these ablation techniques may be effective, no guidelines for or reviews of the combination have been published. Currently, there are three ways of combining EA and RFA: additional RFA is effective for treatment of incompletely resolved symptoms and solid residual portions of a thyroid nodule after EA. Additional EA can be performed for the residual unablated solid portion of a nodule after RFA if it is adjacent to critical structures (e.g., trachea, esophagus, and recurrent laryngeal nerve). In the concomitant procedure, ethanol is injected to control venous oozing after aspiration of cystic fluid prior to RFA of the remaining solid nodule.

Recent progress in the application of radiofrequency ablation in treating benign thyroid nodules / 介入放射学杂志

Thyroid nodules are common clinical disease, and most of the nodules are benign. After radiofrequency ablation (RFA) treatment, the volume of benign thyroid nodules will significantly shrink or the nodules will even disappear, thus, the related clinical symptoms induced by the thyroid nodules will be improved. For recent years, radiofrequency ablation has become the treatment of first choice for benign thyroid nodules. This paper aims to make a comprehensive review about the research situation concerning the radiofrequency ablation in the treatment of the benign thyroid nodules so as to provide scientific guidance and basis for the relevant clinical research and treatment.

Radiofrequency Ablation for Benign Thyroid Nodules Performed by Surgeon / 대한내분비외과학회지

PURPOSE: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. METHODS: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. RESULTS: The median volume before ablation was 7.8 cm³ (range 1.3~43.2 cm³). After ablation, the median volume was 0.9 cm³ (range 0.0-21.6 cm³) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. CONCLUSION: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

The Different Expression of BRAF(V600E) Mutation in Patients with Papillary Thyroid Carcinomas Coexisting with or without Benign Thyroid Nodules / 대한내분비외과학회지

PURPOSE: BRAF(V600E) mutation is the most common genetic alteration in papillary thyroid cancer (PTC) and has been associated with poor prognostic factors. The purpose of the present study is to investigate the frequency of the BRAF mutation in PTC with and without benign thyroid nodules (BN). METHODS: 98 DNA samples were extracted from frozen tissues of 51 PTC and 47 BN specimens of 70 patients and were divided into four group: PTC with BN, PTC alone, BN with PTC and BN alone group. We investigated the BRAF mutation by sequencing and clinicopathologic characteristics. RESULTS: Total positive rate of BRAF mutation was 23.5% in the two PTC groups. That rate of the PTC with BN group was 10.7% and the PTC alone group was 39.1%. Positive rate in the PTC with BN group was lesser than the PTC alone group and had statistically difference (P=0.02). The positive rate of BRAF mutation was 7.1% in the BN with PTC group and 5.3% in the BN alone group. Positive rate in these two group was not statistically different (P=0.80). CONCLUSION: The frequency of BRAF mutation in PTC with concurrent BN was lower than in PTC alone. This result suggests that the effect of BRAF mutation is lesser associated with PTCs with BN than PTC alone group.

Changes of Thyroid Function in Patients Undergoing Partial Thyroidectomy for Benign Thyroid Tumors / 대한내분비외과학회지

PURPOSE: Lobectomy or subtotal thyroidectomy in patients with a benign thyroid tumor or goiter can give rise to hypothyroidism due to the reduced volume of the hormone-secreting thyroid gland. This study investigated the incidence of hypothyroidism in such patients and the clinical risk factors. METHODS: One hundred seven patients who underwent partial thyroidectomy for benign thyroid tumor or goiter from January 2003 to February 2005 in our institution were reviewed retrospectively. Patients who had been preoperatively diagnosed with hyper- or hypothyroidism preoperatively were excluded. Postoperative hypothyroidism was defined as an elevated serum thyroid stimulating hormone (TSH) level >6.5 µIU/L at about 6 months postthyroidectomy. RESULTS: The mean age of the 107 patients was 42.2 years. Ninety patients (84.1%) were female. Subtotal thyroidectomy was performed in 20 patients, lobectomy in 83 patients and enucleation in four patients. The most common pathologic diagnosis was nodular hyperplasia (86.0%). Postoperative hypothyroidism developed after surgery in 19 (21.8%) patients. Patients were evaluated for age, gender, preoperative TSH level, tumor size, tumor number, extent of the resection, thickness of thyroid isthmus and the presence of pathologic thyroiditis or thyroid autoantibody. Advanced age, elevated preoperative TSH level and extensive resection of the thyroid gland were significantly associated with postoperative hypothyroidism. CONCLUSION: Since many patients with a benign thyroid nodule can maintain a normal thyroid function even after thyroidectomy, preservation of more thyroid tissue during the operation is desirable, especially in young patients with a low-normal TSH level, unless the possibility of disease recurrence is high.

Effectiveness of Suppressive Therapy with Levothyroxine in Benign Thyroid Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effectiveness of suppressive therapy with Levothyroxine in benign thyroid nodule is controversial. The favorable response varies between 9-68%. The aim of this study was to evaluate the effect of Levothyroxine suppressive therapy on benign thyroid nodules in comparison with untreated patients. SUBJECTS AND METHOD: A total 98 patients diagnosed with benign thyroid nodules by high resolution ultrasonography and fine needle aspiration cytology from January 2001 to June 2007 was evaluated retrospectively. The case group included 55 patients who received Levothyroxine suppressive therapy for longer than 6 months with documentation of thyroid stimulating hormone (TSH) suppression level. The control group included 43 patients who were followed up without any treatment. We measured TSH, free T4, and thyroid nodule volume by ultrasound every 6 months. RESULTS: In 13 patients (23.6%) of the case group, nodule volume decreased more than 50% after the Levothyroxine suppressive therapy. In 10 (23.2%) of the control group, nodule volume decreased more than 50 % after the follow-up of 6 months. There was no significant difference between the two groups. The change of nodule volume was not related to the TSH suppression level, the number of nodule or the type of nodule. CONCLUSION: We concluded that Levothyroxine suppressive therapy was not effective in volume reduction of benign thyroid nodules.

Treatment Modalities for Benign Thyroid Nodules: Medical Treatment / 대한내분비외과학회지

Thyroid nodules are frequently diagnosed today, mainly due to the wide use of neck ultrasonography (US). The majority of these lesions are benign; suspicion for malignancy is an indication for surgery, while benign thyroid nodules may be managed conservatively. There is evidence that a large percentage of patients with thyroid nodules are over-treated. Careful and accurate identification of patients with thyroid nodules that are highly suspicious for an underlying malignancy would allow for a more reasonable therapeutic approach and would result in a reduction of the number of unnecessary thyroidectomies. Fine needle aspiration cytology is currently the most accurate and cost effective diagnostic approach for the evaluation of patients with nodular thyroid disease. Completely asymptomatic nodules require follow-up without treatment. Cosmetic problems or compression related symptoms may be indications for surgery. When surgery is contraindicated or refused, several non-surgical approaches are available. These include levothyroxine therapy, radioiodine treatment, injection of percutaneous ethanol and laser photocoagulation. Levothyroxine therapy is the most widely used approach, but its clinical efficacy and safety are controversial. Treatment with radioiodine is the therapy of choice for toxic nodules or for symptomatic nodular goiters when surgery is not possible. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Laser therapy should be reserved only for selected patients treated in experienced centers. With these options, clinicians can personalize the management of nodular thyroid disease according to a careful cost benefit analysis.

Total Thyroidectomy as the Treatment of Bilateral Thyroid Benign Nodules that Require Surgery

PURPOSE: A total thyroidectomy for the treatment of bilateral thyroid benign nodules is still controversial. This study prospectively compared the prognosis and complications of a total thyroidectomy with those after a subtotal thyroidectomy. METHODS: Between September 2003 and October 2006, a total of 110 consecutive patients with bilateral thyroid benign nodules underwent either a total (n=77) or subtotal thyroidectomy (n=33). Temporary or permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy, operation time, the length of hospital stay, postoperative thyroxine dosage in both operation groups were compared. In addition, the detection rate of a malignancy through a permanent biopsy was examined. RESULTS: There was a higher rate of temporary hypoparathyroidism, longer length of hospital stay and higher thyroxine dosage needed in the total thyroidectomy group than in the subtotal thyroidectomy group. There were no significant differences in the permanent hypoparathyroidism, temporary or permanent recurrent laryngeal nerve palsy and operation time between the two groups. The histopathological diagnosis was a malignant tumor in 13 patients. CONCLUSION: This study suggests that a total thyroidecotmy can be performed without increasing risk of complications. A total thyroidectomy avoids recurrent nodules for the removal of the whole thyroid tissue, which avoids the need for secondary surgery with an increased risk of complications when compared with primary thyroid surgery. A total thyroidecotmy is considered the first choice for the management of bilateral thyroid benign nodules.

Post-Operative Long-Term Results of Patients with Benign Thyroid Nodules / 대한내분비외과학회지

PURPOSE: Patients with benign thyroid nodules, presenting symptoms such as dysphagia and choking sensation, increasing tendency of nodular size, or failure of medical treatment, may need surgical management. However, the guidelines for surgical management and optimal extent of resection for benign thyroid nodules were not definitely established until yet. The aim of this study is to evaluate the complications related with extent of surgical resection and to determine the optimal surgical procedure for benign thyroid nodules through long-term results. METHODS: Fifty-five cases with benign thyroid nodules who received surgery at Department of Surgery, Chonnam National University Hospital Jan. 1993 to Dec. 1996 were retrospectively evaluated. Inclusion of criteria were follows: pathologically benign, with normal on preoperative thyroid function study, follow-up period with 5 years or more. Follow-up studies were consisted of physical examination, neck ultrasonography, thyroid function test, determination of serum PTH-i and serum calcium level, and laryngoscopic examination if necessary. RESULTS: Male to female ratio was 1 to 6.8. Fourth and fifth decades occupied majority (58.2%) of patients. The most common symptom at initial diagnosis was palpable mass on the cervical area (90.9%), followed by palpitation (5.6%) and voice change (5.6%) as their complaints in decreasing order. Average follow-up period was 6.3 years, complications after surgery such as hypoparathyroidism were more frequent in total and subtotal thyroidectomy group than lobectomy group. However, nodular recurrence in remanant thyroid tissues was 13.8% in lobectomy and 9% in subtotal thyroidectomy, The significant factors associated with recurrence were absent, except for age. CONCLUSION: Although remnant thyroid tissue have potential of nodular recurrence, total thyroidectomy have a more risk of permanent hypoparathyroidism. Therefore, we would like to recommend that surgical extent for benign thyroid nodules need to be determinated by experience and skill of surgeon and patient's compliance for long-term medication and regular follow-up study to detect nodular recurrence in remanant thyroid earlier.

Percutaneous Intranodular Injection Therapy of Radioiodine in Treatment of Benign Thyroid Nodules: A Preliminary Study / 대한내분비외과학회지

PURPOSE: Percutaneous ethanol injection therapy has been used in the treatment of the benign thyroid diseases. Although the reported side-effects of the therapy was mild and transient, some side-effects including local or radiating pain are troublesome to the patients. Radioactive iodine also has been effectively and safely used for management of the benign thyroid diseases. So we developed the percutaneous intranodular injection therapy of radioactive iodine as an alternative of percutaneous ethanol injection therapy. METHODS: From December 1998 to October 1999, we treated 29 outpatients (25 women and 4 men, mean age: 47±12 years). Inclusion criteria were follows; age > 30 years, cytologically benign, with normal thyroid function, cold nodule on thyroid scintigram, solid or mixed natured nodules in sonographical evaluation. Nodular volume was estimated by sonography according to the ellipsoid formula. Radioactive iodine (0.1 mCi/ml) was administered in a single dose injection. Follow-up studies every 3 months consisted of full history, thyroid function test, and sonography. We determined the therapeutic response is effective if the volume reduction of the nodule occurred above 30%. ESULTS: RAfter at least 3 months follow-up, 11 patients showed effective response, 12 patients showed minimal or unchanged response and 6 patients showed progression. Although side-effects such as injection pain, febrile reaction, and hormonal changes were absent, an infectious complication in injection site was developed from 1 case. CONCLUSION: Although we need a more prolonged follow-up to evaluate the delayed sequelae, we can suggest that percutaneous intranodular injection therapy of radioiodine may be an attractive non-surgical treatment in selected cases of benign thyroid nodules.