Surgical Versus Non Surgical Management of Thyroid Nodule

Study Overview
=================
Brief Summary
-----------------
To compare between surgical (hemi thyroidectomy and total thyroidectomy) and non-surgical (medical, ethanol injection,thermal ablation and laser photo coagulation) management of simple thyroid nodule regarding: Outcome of every type of management Feasibility of minimally invasive technique in management of simple thyroid nodule in Asyut university Complication of every type of management

Detailed Description
-----------------
Thyroid nodules are very common in clinical practice; they are discovered by palpation in 3-7% and by ultrasound (US) in about 50% of the general population. The majority of thyroid nodules are benign and asymptomatic. The main management of benign thyroid nodules is observation and follow-up; however, a minority of them (10-15%) increase in size over time and may induce symptoms or cosmetic issues. Surgical excision has been established as a treatment for symptomatic benign thyroid nodules. thyroidectomy for benign thyroid disease continues to remain controversial, as there are many conflicting data published in the literature regarding the risk of hypothyroidism and recurrent laryngeal nerve injury stratified to indications for surgery, extent of thyroid resection and surgical volume .It carries a 2-10% risk of complications and neck scarring .Thyroid surgery is also costly and may not be appropriate for patients who have a high risk of surgical morbidity.Therefore, image-guided nonsurgical procedures such as ethanol ablation (EA) and thermal ablation have been proposed as alternative and less invasive approaches for the management of benign symptomatic thyroid nodules .These so-called thermoablative methods induce local thermodestruction, leading to nodule shrinkage and improvement of local symptoms. Monopolar radiofrequency ablation (RFA) and EA is widely used as a nonsurgical treatment usually for cystic (i.e., pure cyst) or predominantly cystic benign thyroid nodules (i.e., cystic portion > 50%). There is another method called US-guided percutaneous laser ablation (PLA) is a safe and effective therapeutic option as an alternative to surgery for benign symptomatic nodules

Official Title
-----------------
Surgical (Total or Hemithyroidectomy)Versus Non Surgical (Ethanol Ablation ,RF Ablation ,Laser Ablation) Management of Thyroid Nodule

Conditions
-----------------
Thyroid Nodule

Intervention / Treatment
-----------------
* Procedure: thyroidectomy


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: complicated thyroid nodule Exclusion Criteria: less than 18 malignant thyroid nodule

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: age above 18 male or female manifested thyroid nodule
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: total thyroidectomy<br>excision of thyroid gland | Procedure: thyroidectomy<br>* to excise the thyroid gland<br>* Other names: ethanol ablation RF ablation laser photocaugulation;|
| Active Comparator: hemi thyroidectomy<br>excision half of thyroid gland | Procedure: thyroidectomy<br>* to excise the thyroid gland<br>* Other names: ethanol ablation RF ablation laser photocaugulation;|
| Active Comparator: ethanol ingection<br>ingection of ethanol into thyroid nodule under guidance of ultrasound | Procedure: thyroidectomy<br>* to excise the thyroid gland<br>* Other names: ethanol ablation RF ablation laser photocaugulation;|
| Active Comparator: monopolar radiofrequency<br>using radiofrequency for ablation of thyroid nodule | Procedure: thyroidectomy<br>* to excise the thyroid gland<br>* Other names: ethanol ablation RF ablation laser photocaugulation;|
| Active Comparator: laser photocaugulation<br>using laser for ablation of thyroid nodule | Procedure: thyroidectomy<br>* to excise the thyroid gland<br>* Other names: ethanol ablation RF ablation laser photocaugulation;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| shrinkage of the thyroid nodule | decrease in the size of thyroid nodule | 2 years |