Ultrasound-guided Radiofrequency Ablation versus radioactive Iodine as treatment for Hyperthyroidism caused by Solitary Autonomous Thyroid Nodules (RABITO study)
- Conditions
- Hyperactive thyroid nodules
- Registration Number
- 2024-515602-34-01
- Lead Sponsor
- Rijnstate Ziekenhuis Stichting
- Brief Summary
To compare the one-year incidence of irreversible hypothyroidism after RAI or RFA treatment for HTN
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Authorised, recruitment pending
- Sex
- Not specified
- Target Recruitment
- 232
Age > 18 years
Hyperthyroidism or subclinical hyperthyroidism caused by a solitary hyperactive thyroid nodule (HTN), either located in an otherwise normal thyroid gland, or in a multinodular goitre (MNG), with a diagnosis based on the following characteristics: o Blood TSH level below the lower limit of normal, and associated with either normal or elevated FT4 and FT3/T3 levels o Anti-TSH antibody negative o Solitary HTN confirmed by a diagnostic I-123 or I-131scintigraphy* , corresponding with a well demarcated thyroid node on ultrasound, cystic degeneration < 75%, nodule size <50 mm.
Treatment with RAI indicated, and eligible for RFA treatment
Signed informed consent
Multifocal HTN: These patients should be treated according the current standard of care: RAI, surgery or ATD treatment.
HTN > 50 mm: There is some evidence to suggest that nodule size adversely affects the efficacy of RAI and RFA. Therefore, surgery is recommended as the option of first choice in such cases.
Insufficient suppression of thyroid tissue on thyroid scintigraphy. Fractional uptake will be determined by the Rijnstate research team. One region of interest (ROI) will be drawn around the whole thyroid and a second ROI around the hot nodule. The counts in these ROI’s will be divided and using a cut-off of ≥0.85 of uptake in the ROI of the nodule.
Medical history of Graves disease, I-131 treatment, RFA of the same nodule or thyroid malignancy
Presence of a medical device susceptible to disturbances caused by RFA generated currents.
Patients with physical or behavioural disorders that preclude safe isolation in radiation protection rooms, or safe RFA procedure under local or general anesthesia.
Patients with dysphagia, oesophageal stenosis, active gastritis, gastric erosion, a peptic ulcer or impaired gastro-intestinal motility.
Uncorrectable haemorrhagic diathesis.
Pregnant or breastfeeding women.
Study & Design
- Study Type
- Interventional clinical trial of medicinal product
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Cumulative incidence of irreversible hypothyroidism in the first year after intervention. Irreversible primary hypothyroidism is defined as: 1) (A)symptomatic elevation of TSH levels in the range of 5 - 10 mU/L for at least 10-12 weeks and without signs of recovery, confirmed by repeated measurements; or as (a)symptomatic hypothyroidism with TSH levels > 10 mU/L for more than 4 weeks, without signs of recovery, confirmed on at least two separate occasions. Cumulative incidence of irreversible hypothyroidism in the first year after intervention. Irreversible primary hypothyroidism is defined as: 1) (A)symptomatic elevation of TSH levels in the range of 5 - 10 mU/L for at least 10-12 weeks and without signs of recovery, confirmed by repeated measurements; or as (a)symptomatic hypothyroidism with TSH levels > 10 mU/L for more than 4 weeks, without signs of recovery, confirmed on at least two separate occasions.
- Secondary Outcome Measures
Name Time Method Cure rate at 1 year, complete cure is defined as a normalization of TSH, FT4 and FT3 /T3levels. Cure rate at 1 year, complete cure is defined as a normalization of TSH, FT4 and FT3 /T3levels.
Thyroid nodule volume assessed by ultrasound at baseline, 6, and 12 months. Thyroid nodule volume assessed by ultrasound at baseline, 6, and 12 months.
Fractional nodal uptake assessed by I-123 or I-131 scintigraphy, at baseline and 12 months. Fractional nodal uptake assessed by I-123 or I-131 scintigraphy, at baseline and 12 months.
Thyroid antibodies at 0 and 12 months, to monitor treatment-related autoimmunity. Thyroid antibodies at 0 and 12 months, to monitor treatment-related autoimmunity.
Treatment related adverse events, number of adverse and serious adverse events at 6 weeks, and 3, 6 and 12 months. Treatment related adverse events, number of adverse and serious adverse events at 6 weeks, and 3, 6 and 12 months.
Thyroid related quality of life, assessed by ThyPro questionnaire at baseline, and 6 and 12 months after treatment. Thyroid related quality of life, assessed by ThyPro questionnaire at baseline, and 6 and 12 months after treatment.
Health outcomes and quality of life at one year, based on the European QoL-5 Dimensions (EQ-5D-5L) questionnaire Health outcomes and quality of life at one year, based on the European QoL-5 Dimensions (EQ-5D-5L) questionnaire
Use of health care resources during the first year after treatment, according to medical records, iMCQ and iPCQ. Use of health care resources during the first year after treatment, according to medical records, iMCQ and iPCQ.
Cumulative costs at 1 year Cumulative costs at 1 year
Cost-effectiveness at 1 year is determined as the incremental costs in Euros per quality adjusted life year (QALY), assessed by the European QoL-5 Dimensions (EQ-5D-5L) at baseline and 6 weeks, 3, 6, 9 and 12 months after treatment and use of health care resources during the first 12 months Cost-effectiveness at 1 year is determined as the incremental costs in Euros per quality adjusted life year (QALY), assessed by the European QoL-5 Dimensions (EQ-5D-5L) at baseline and 6 weeks, 3, 6, 9 and 12 months after treatment and use of health care resources during the first 12 months
Course of thyroid function as assessed by TSH, FT4 and FT3 at baseline and during a one year follow-up with an extension of follow-up up to 5 years Course of thyroid function as assessed by TSH, FT4 and FT3 at baseline and during a one year follow-up with an extension of follow-up up to 5 years
Short-term patient satisfaction assessed by interviews, a satisfaction questionnaire, pain scoring by visual analog scale (VAS). Short-term patient satisfaction assessed by interviews, a satisfaction questionnaire, pain scoring by visual analog scale (VAS).
Trial Locations
- Locations (14)
Laurentius Ziekenhuis Roermond
🇳🇱Roermond, Netherlands
Gelre Hospitals
🇳🇱Apeldoorn, Netherlands
Stichting Martini Ziekenhuis
🇳🇱Groningen, Netherlands
Ziekenhuisgroep Twente Stichting
🇳🇱Almelo, Netherlands
Catharina Ziekenhuis Stichting
🇳🇱Eindhoven, Netherlands
Elkerliek Ziekenhuis
🇳🇱Helmond, Netherlands
Haga Hospital
🇳🇱's-Gravenhage, Netherlands
Stichting Amsterdam UMC
🇳🇱Amsterdam, Netherlands
Spaarne Gasthuis Stichting
🇳🇱Haarlem, Netherlands
Rijnstate Ziekenhuis Stichting
🇳🇱Arnhem, Netherlands
Scroll for more (4 remaining)Laurentius Ziekenhuis Roermond🇳🇱Roermond, NetherlandsFemke DeelenSite contact0rabitostudie@rijnstate.nl