Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule - Sorbonne Université
Journal Articles AACE Clinical Case Reports Year : 2021

Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule

Abstract

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) mUI/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.
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Dates and versions

hal-03254160 , version 1 (08-06-2021)

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Adrien Ben Hamou, Hervé Monpeyssen. Horner’s Syndrome During High-Intensity Focused Ultrasound Ablation for a Benign Thyroid Nodule. AACE Clinical Case Reports, 2021, 7 (3), pp.164 - 168. ⟨10.1016/j.aace.2020.11.035⟩. ⟨hal-03254160⟩
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