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갑상선 결절의 비수술적 치료

Non-surgical Management of Thyroid Nodules

윤정한|조진성
대한내분비외과학회 (Korean Association of Endocrine Surgeons)|2012.09|Journal of Endocrine Surgery|제12권 제3호|pp. 157-165

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참고문헌

키워드

갑상선 호르몬LevothyroxineLaser ablationRadiofrequency ablation에탈올 경화요법고주파 절제술레이저 소작술Ethanol ablation

초록

Thyroid nodules are a common clinical problem. Routine use of neck ultrasonography increase in the frequency of nodular thyroid disease, however, only a small percentage of the nodules currently being detected will prove to be malignant. The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 5∼10% of cases. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Fine-needle aspiration cytology has a central role in identification of malignant nodules, which are generally treated with surgery. Benign nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems with or without compressive symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include TSH suppressive therapy, radioactive iodine treatment, ethanol ablations, laser ablation, and radiofrequency ablation. TSH suppressive therapy is the most widely used, however, its clinical efficacy and safety are controversial. When surgery is not available, radioactive iodine therapy is the therapy of choice for treatment of toxic nodules or symptomatic nodular goiters. Ethanol ablation can be used as the first-line therapy for treatment of symptomatic cystic nodules. Radiofrequency ablation is another safe and effective treatment for benign nodules and may also have an effective complementary role in management of recurrent thyroid cancers. Laser photocoagulation should be reserved for selected patients undergoing treatment in experienced centers. Through higher understanding of thyroid and neck anatomy, surgeons should actively participate in various non-surgical managements.

Abstract

Thyroid nodules are a common clinical problem. Routine use of neck ultrasonography increase in the frequency of nodular thyroid disease, however, only a small percentage of the nodules currently being detected will prove to be malignant. The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 5∼10% of cases. Most thyroid nodules are cytologically benign and can be managed nonsurgically. Fine-needle aspiration cytology has a central role in identification of malignant nodules, which are generally treated with surgery. Benign nodules that are completely asymptomatic require follow-up without treatment. Cosmetic problems with or without compressive symptoms may be indications for surgery. When surgery is contraindicated or refused, several nonsurgical approaches are available. These include TSH suppressive therapy, radioactive iodine treatment, ethanol ablations, laser ablation, and radiofrequency ablation. TSH suppressive therapy is the most widely used, however, its clinical efficacy and safety are controversial. When surgery is not available, radioactive iodine therapy is the therapy of choice for treatment of toxic nodules or symptomatic nodular goiters. Ethanol ablation can be used as the first-line therapy for treatment of symptomatic cystic nodules. Radiofrequency ablation is another safe and effective treatment for benign nodules and may also have an effective complementary role in management of recurrent thyroid cancers. Laser photocoagulation should be reserved for selected patients undergoing treatment in experienced centers. Through higher understanding of thyroid and neck anatomy, surgeons should actively participate in various non-surgical managements.

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