Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule
Objective: Horner’s syndrome (HS) is a rare complication of high-intensity focused ultrasound (HIFU) and radiofrequency ablation for thyroid nodules. We present such a case and discuss how to avoid this complication in the future. Methods: This case occurred during HIFU treatment of a benign thyroid...
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-05-01
|
| Series: | AACE Clinical Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2376060521000018 |
| _version_ | 1818456490562813952 |
|---|---|
| author | Adrien Ben Hamou, MD Hervé Monpeyssen, MD |
| author_facet | Adrien Ben Hamou, MD Hervé Monpeyssen, MD |
| author_sort | Adrien Ben Hamou, MD |
| collection | DOAJ |
| description | Objective: Horner’s syndrome (HS) is a rare complication of high-intensity focused ultrasound (HIFU) and radiofrequency ablation for thyroid nodules. We present such a case and discuss how to avoid this complication in the future. Methods: This case occurred during HIFU treatment of a benign thyroid nodule (BTN). Ultrasound and fine-needle aspiration cytology (FNAC) were performed before the procedure. Volume reduction was evaluated at 6 weeks, 3, 6, and 12 months. Technical success was ≥50% reduction at 6 months. Results: A 30-year-old woman presented with a solitary symptomatic thyroid nodule. Her thyroid stimulating hormone was 1.16 (ref 0.4-3.6) μUI/mL), ultrasound found a 13 mL right-thyroid EU-TIRADS 4 nodule. Two FNACs were read as Bethesda II. The subsequent HIFU procedure was conducted with local 2% lidocaine anesthesia. The procedure was painful (visual analogic scale 10/10) and ipsilateral partial ptosis occurred during the procedure. Volume reduction at 12 months was 34.6% of the initial volume with persisting functional and cosmetic complaints, discomfort, and partial ptosis. As the volume reduction was ≤50%, the procedure was a technical failure. A new FNAC was read as Bethesda IV. A right lobectomy was performed without postoperative outcomes and without requiring hormonal replacement therapy. Pathological evaluation found no malignant cells. Conclusion: HS is a rare complication of HIFU for management of BTNs. It may be symptomatic and have sequalae that persist for months. Severe neck pain may by associated, but further investigation is needed. |
| first_indexed | 2024-12-14T22:27:30Z |
| format | Article |
| id | doaj.art-e0e0a46c06724a02ba89b5ede328c2fb |
| institution | Directory Open Access Journal |
| issn | 2376-0605 |
| language | English |
| last_indexed | 2024-12-14T22:27:30Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AACE Clinical Case Reports |
| spelling | doaj.art-e0e0a46c06724a02ba89b5ede328c2fb2022-12-21T22:45:19ZengElsevierAACE Clinical Case Reports2376-06052021-05-0173164168Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid NoduleAdrien Ben Hamou, MD0Hervé Monpeyssen, MD1American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, France; Thyroid and Endocrine Tumors Department, Institute of Endocrinology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France; Address correspondence and reprint requests to Dr. A. Ben Hamou, American Hospital of Paris – Thyroid Unit, 63 Boulevard Victor Hugo, 92200, Neuilly-sur-Seine.American Hospital of Paris, Thyroid Unit, Neuilly-sur-Seine, FranceObjective: Horner’s syndrome (HS) is a rare complication of high-intensity focused ultrasound (HIFU) and radiofrequency ablation for thyroid nodules. We present such a case and discuss how to avoid this complication in the future. Methods: This case occurred during HIFU treatment of a benign thyroid nodule (BTN). Ultrasound and fine-needle aspiration cytology (FNAC) were performed before the procedure. Volume reduction was evaluated at 6 weeks, 3, 6, and 12 months. Technical success was ≥50% reduction at 6 months. Results: A 30-year-old woman presented with a solitary symptomatic thyroid nodule. Her thyroid stimulating hormone was 1.16 (ref 0.4-3.6) μUI/mL), ultrasound found a 13 mL right-thyroid EU-TIRADS 4 nodule. Two FNACs were read as Bethesda II. The subsequent HIFU procedure was conducted with local 2% lidocaine anesthesia. The procedure was painful (visual analogic scale 10/10) and ipsilateral partial ptosis occurred during the procedure. Volume reduction at 12 months was 34.6% of the initial volume with persisting functional and cosmetic complaints, discomfort, and partial ptosis. As the volume reduction was ≤50%, the procedure was a technical failure. A new FNAC was read as Bethesda IV. A right lobectomy was performed without postoperative outcomes and without requiring hormonal replacement therapy. Pathological evaluation found no malignant cells. Conclusion: HS is a rare complication of HIFU for management of BTNs. It may be symptomatic and have sequalae that persist for months. Severe neck pain may by associated, but further investigation is needed.http://www.sciencedirect.com/science/article/pii/S2376060521000018benign thyroid noduleimage-guided ablationhigh-intensity focused ultrasound (HIFU)Horner’s syndrome |
| spellingShingle | Adrien Ben Hamou, MD Hervé Monpeyssen, MD Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule AACE Clinical Case Reports benign thyroid nodule image-guided ablation high-intensity focused ultrasound (HIFU) Horner’s syndrome |
| title | Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule |
| title_full | Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule |
| title_fullStr | Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule |
| title_full_unstemmed | Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule |
| title_short | Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule |
| title_sort | horner s syndrome during high intensity focused ultrasound ablation for a benign thyroid nodule |
| topic | benign thyroid nodule image-guided ablation high-intensity focused ultrasound (HIFU) Horner’s syndrome |
| url | http://www.sciencedirect.com/science/article/pii/S2376060521000018 |
| work_keys_str_mv | AT adrienbenhamoumd hornerssyndromeduringhighintensityfocusedultrasoundablationforabenignthyroidnodule AT hervemonpeyssenmd hornerssyndromeduringhighintensityfocusedultrasoundablationforabenignthyroidnodule |