This book covers an astonishing amount of information in its near thousand pages, everthing from basic laser physics to dental, and veteranary useage. Here are some of its contents:
Basic Laser Physics
physics
energy
radiation
wavelength and frequency
photon energy
the elecromagnetic spectrum
the optical reigon
radiation risks
can electromagnetic radiation cause cancer
protective mechanisms
light
the optical spectrum
light sources
various sources of radiation
natural sources of radiation
man-made light sources
the light emmiting diode (LED)
flash lamps
the laser
laser design
practical lasers
the properties of laser light coherence
interference
laser beam characteristics
polarisation
output power
continuous and pulsed lasers
the peak power value
average power output
power density
light distribution
beam divergence
collimation
risk of eye injury
decisive factors in the risk of eye injury
the laser instrument
properties of some laser types
description of common surgical laser types
the CO2 laser (carbon dioxide laser)
carbon dioxide lasers in surgery
carbon dioxide lasers in dental applications
the Nd:YAG laser
Nd:YAG lasers in surgery
Nd:YAG lasers in dentistry
erbium lasers in dentistry
"strong" diode lasers in dentistry
the KTP laser
Q-switching
Theraputic Lasers
the first generation 1975-85
the second generation 1985-95
the third generation 1995-2005
the fourth generation 2005 and onwards
what is a good laser therapy instrument
the basic instrument
sales tricks
high power-low power
laser or LED
high or low price
penetration of light into tissue
"a story of a young scientist"
the wavelength
how deep does light penetrate into tissue?
Biostimulation
history
a few words on mechanisms
photoreceptors
what parameters to use
laser parameters
whitch wavelength?
output power
average output power
power density
energy density
the dose
treatment dose
calculation of doses
dose ranges
calculation of treatment time for a desired dose
"reay reckoner"
dose per point
pulsed or continuous light
pulse repetition rate (PRP)
patient parameters
treatment area
treatment intervals
pre- or postoperative treatment
treatment method parameters
local treatment
shallow problems
deeper problems
treating inside the body
systemic treatments
acccupuncture
trigger points
spinal processes
dermatome
blood irradiation
irradiation of lymph nodes
irradiation of ganglions
combo treatment
interaction with medication
other considerations
what about collimation?
depth of penetration, greatest active depth
factors that reduce penetration
tissue compression
how deep does the light penetrate?
laser light irradiation through clothes
the importance of tissue and cell condition
the importance of ambient light
in vitro/ in vivo
laser therapy with high output lasers
laser therapy with carbon dioxide lasers
laser therapy with Nd:YAG lasers
laser therapy with ruby lasers
laser therapy with Er:YAG lasers
laser therapy with surgical diode lasers
risks and side effects
the importance of correct diagnose
cancer
cytogentic effects?
a false picture of health
tiredness
pain reaction
do high doses of laser therapy damage tissue?
is it only an effect of temperature?
protection against radiation injury
how to measure effects of laser therapy
thermography
magnetic resonance imaging
high resolution digitized ultrasound B-scan
tensile strength
other objective methods
does it have to be a laser?
FDA (Food and Drug Administration)
how well documented?
confused?
the funding research
as time goes by
Medical indications
who and what can be treated?
acne
allergy
antibiotic resistance
arteriosclerosis
arthritis
asthma
blood preservation
blood pressure
bone regeneration
burning mouth syndrome
cancer
cardiac conditions
carpal tunnel syndrome
cerebral palsy
crural and venous ulcers
delayed onset muscular soreness (DOMS)
depression, psychosomatic problems
diabetes
duodenal/gastric ulcer
epicondylitis
erythema multiform major
fibrositis/fribomyalgia
headache/migraine
heamorrhoids
herpes simplex
immune system modulation
inflammation
inner ear conditions
laryngitis
lichen
low back pain
mastitis
microcirculation
morbus sluder
mucositis
muscle regeneration
mycosis
nerve conduction
nerve regeneration and function
oedema
ophthalmic problems
pain
periostitis
plantar fasciitis
salivary glands
sinuitis
spinal cord injuries
snake bites
sports injuries
stem cells
stroke, irradiation of the brain
tendinopathies
tinnitus, vertigo, meniere's disease
tonsillitis
trigeminal neuralgia
thrombophlebitis
tuberculosis
urology
warts
wiplash-assosiated dissorders
vitiligo
womens' health
wound healing
zoster
idications in the pipeline
alzheimer's disease
botox failures
cellulites
cholesterol reduction
complex reigonal pain syndrom (CRPS)
eczema
erectile dysfunction
familiar amyotrophic lateral sclerosis (FALS)
glomerulonephritis
obesity
orofacial granulomatosis
Parkinson's disease
post-mestrual stress
pemphigus vulgaris
sleeping disorders
withdrawal periods
wrinkles
consumer lasers
Dental LPT
the dental laser literature
on which patients can LPT be used?
dental indications
alveolitis
anaesthetics
aphthae
bleeding
bisphosphonate related osteonecrosis of the jaw
caries
dentitio dificilis (pericoronitis)
endodontics
extraction
gingivitus
herpes zoster
hypersensitive dentine
implantology
leukoplakia
lingua geographica (glossitis)
lip wounds
nausea
nerve injury
orthodontics
mild dental pain
paediatric dental treatment
periodontics
prosthetics
root fractures
secondary dentine formations
temperature caveats
toemporo-mandibular disorders (TMD)
TMD and endodontics
other dental laser applications
dental pohoto dynamic therapy
composite curing
deminerallisation
tooth bleaching
caries detection
lasers as a diagnostic tool
case reports
Non Coherent Light Sources
Veterinary Use
case reports
Contra Idications
pacemakers
pregnancy
epilepsy
thyroid gland
children
cancer
haemophilia
irradiation of the brain
radiation therapy patients
diabetes
tatoos
light sensitivity
Coherence
the role of coherence in laser phototherapy
itroduction
summary
Dose and Intensity
basics about energy
output power
power density
the laser beam
the laser probe
pulsed lasers
energy density
treatment dose
the dose does not demend on the intensity
dose per point
more about treatment technique
The Mechanisms
are biostimulative effects laser specific?
is it possible to prove that laser therapy doesn't work?
comparisons between coherent and non-coherent light
what is the importance of the length of coherence
hode's hamburger
hode's big burger
abrahamson's apple
moonlight
how deep does light penetrate tissue?
bright light phototherapy
similarities and differences
possible primary mechanisms
polarisation effects
what characterises the light in a laser speckle
porphyrins and polarised light
cell cultures and tissue have different optical properties
tthe effect of heat development in the tissue
macroscopic heating
the microscopic heat effect
mechanical forces
excitation effects
primary reactions due to excitation
secondary reactions due to cell signaling
flourescence-luminescence
multi-photon effects
llasting effects in tissue
non-linear optical effects
opto-acoustic waves
secondary mechanisms
effects on pain
effects on blood circulation
stimulatory and regulatory mechanisms
effects on the immune system
other interesting possibilities
summary of mechanisms
diagnostics with therapeutic lasers
photodynamic therapy - PDT
other medical uses of lasers
A Guide for Scientific Work
methodology of a trial
parameters
technical parameters
treatment parameters
medical parameters
closer description of the technical parameters
name of instrument (producer)
laser type and wavelength
laser beam characteristics
number of sources
beam delivery system
output power
power density at probe aperture
calibration of the instrument
closer description of the treatment parameters
treatment area
dose: energy density
dose per treatment and total dose
intensity: power density
treatment method
treatment distance (spot size), type of movement, scanning
sites of treatment
number of treatment sessions
frequency of treatment sessions
closer description of the medical parameters
description of the problem to be treated
patients (number, age, sex)
exclusion criteria
inclusion criteria
condition of patient
pre-, parallel-, or post-medication
treated with other methods before
drop-out rates
follow up
outcome measures
statistical analysis
economy
gallium-alluminium and all that
recommendations of WALT - the world assosiation for laser therapy
The Laser Phototherapy Literature
the importance of reporting all laser parameters - even in the abstract
diclofenac, dexamethasone or laser phototherapy?
another pithole in LPT research
database of abstracts of reviews of effects (DARE)
Evaluation of low intensity laser effects on the thyroid gland of male mice.
Azevedo LH1, Aranha AC, Stolf SF, Eduardo Cde P, Vieira MM. - Photomed Laser Surg. 2005 Dec;23(6):567-70. (Publication) 3437 Using 4j/cm, a statistically significant hormonal level alteration between the first day and 7 days after the last irradiation was found.
Intro: The purpose of this study was to assess whether there were alterations in the thyroid hormone plasma levels under infrared laser irradiation, in the thyroid gland region.
Background: The purpose of this study was to assess whether there were alterations in the thyroid hormone plasma levels under infrared laser irradiation, in the thyroid gland region.
Abstract: Abstract
OBJECTIVE:
The purpose of this study was to assess whether there were alterations in the thyroid hormone plasma levels under infrared laser irradiation, in the thyroid gland region.
BACKGROUND DATA:
Studies have demonstrated that infrared laser can cause alterations in thyroid glands.
METHODS:
Sixty-five albino male mice were used and assigned to five groups (n = 13), with differences in the times that they were sacrificed. Irradiation procedures consisted of an infrared diode laser emitting at 780 nm, at 4 J/cm(2) energy density, in contact mode, point manner. Blood was collected before irradiation (group 1), and then at 24 h (group 2), 48 h (group 3) and 72 h (group 4), and 1 week (group 5) after the third irradiation. The collected material was used for clinical analysis to evaluate the T(3) (triiodothyronine) and T(4) (thyroxin) hormones. Five animals were used for light microscopy analysis.
RESULTS:
A statistically significant hormonal level alteration between the first day and 7 days after the last irradiation was found.
CONCLUSIONS:
It was concluded that low-level laser therapy (LLLT) of the thyroid gland may affect the level of thyroidal hormones.
Methods: Studies have demonstrated that infrared laser can cause alterations in thyroid glands.
Results: Sixty-five albino male mice were used and assigned to five groups (n = 13), with differences in the times that they were sacrificed. Irradiation procedures consisted of an infrared diode laser emitting at 780 nm, at 4 J/cm(2) energy density, in contact mode, point manner. Blood was collected before irradiation (group 1), and then at 24 h (group 2), 48 h (group 3) and 72 h (group 4), and 1 week (group 5) after the third irradiation. The collected material was used for clinical analysis to evaluate the T(3) (triiodothyronine) and T(4) (thyroxin) hormones. Five animals were used for light microscopy analysis.
Conclusions: A statistically significant hormonal level alteration between the first day and 7 days after the last irradiation was found.
Intro: One inescapable feature of life on the earth is exposure to ionizing radiation. The thyroid gland is one of the most sensitive organs to gamma-radiation and endocrine disrupters. Low-level laser therapy (LLLT) has been used to stimulate tissue repair, and reduce inflammation. The aim of this study was to gauge the value of using Helium-Neon laser to repair the damaged tissues of thyroid gland after gamma-irradiation. Albino rats were used in this study (144 rats), divided into control, gamma, laser, and gamma plus laser-irradiated groups, each group was divided into six subgroups according to time of treatment (total six sessions). Rats were irradiated once with gamma radiation (6 Gy), and an external dose of laser (Wavelength 632.8 nm, 12 mW, CW, Illuminated area 5.73 cm(2), 2.1 mW cm(-2) 120 s, 1.4 J, 0.252 J cm(-2)) twice weekly localized on thyroid region of the neck, for a total of six sessions. Animals were sacrificed after each session. Analysis included thyroid function, oxidative stress markers, liver function and blood picture. Results revealed improvement in thyroid function, liver function and antioxidant levels, and the blood cells count after LLLT.
Background: One inescapable feature of life on the earth is exposure to ionizing radiation. The thyroid gland is one of the most sensitive organs to gamma-radiation and endocrine disrupters. Low-level laser therapy (LLLT) has been used to stimulate tissue repair, and reduce inflammation. The aim of this study was to gauge the value of using Helium-Neon laser to repair the damaged tissues of thyroid gland after gamma-irradiation. Albino rats were used in this study (144 rats), divided into control, gamma, laser, and gamma plus laser-irradiated groups, each group was divided into six subgroups according to time of treatment (total six sessions). Rats were irradiated once with gamma radiation (6 Gy), and an external dose of laser (Wavelength 632.8 nm, 12 mW, CW, Illuminated area 5.73 cm(2), 2.1 mW cm(-2) 120 s, 1.4 J, 0.252 J cm(-2)) twice weekly localized on thyroid region of the neck, for a total of six sessions. Animals were sacrificed after each session. Analysis included thyroid function, oxidative stress markers, liver function and blood picture. Results revealed improvement in thyroid function, liver function and antioxidant levels, and the blood cells count after LLLT.
Effect of three different protocols of low-level laser therapy on thyroid hormone production after dental implant placement in an experimental rabbit model.
Intro: The purpose of this study was to assess the systemic effects of low-level laser therapy (LLLT) on thyroid gland function and, consequently, calcium regulation - as measured by serum triiodothyronine (T3), thyroxine (T4), and free calcium levels - when administered after dental implant placement in a rabbit model.
Background: The purpose of this study was to assess the systemic effects of low-level laser therapy (LLLT) on thyroid gland function and, consequently, calcium regulation - as measured by serum triiodothyronine (T3), thyroxine (T4), and free calcium levels - when administered after dental implant placement in a rabbit model.
Abstract: Abstract
OBJECTIVE:
The purpose of this study was to assess the systemic effects of low-level laser therapy (LLLT) on thyroid gland function and, consequently, calcium regulation - as measured by serum triiodothyronine (T3), thyroxine (T4), and free calcium levels - when administered after dental implant placement in a rabbit model.
BACKGROUND DATA:
Protocols for the use of laser therapy in several clinical procedures are currently under investigation, as not all of the actions and systemic effects of laser irradiation have been clearly established.
MATERIALS AND METHODS:
Forty male adult New Zealand rabbits were distributed across five groups of eight animals each: two control groups (C-I and C-II) of unirradiated animals, and three experimental groups (E-5, E-10, and E-20), each exposed to a distinct dose of gallium-aluminum-arsenide (GaAlAs) laser [λ=830 nm, 50 mW, continuous wave (CW)] every 48 h for a total of seven sessions. The total dose per session was 5 J/cm(2) in E-5, 10 J/cm(2) in E-10, and 20 J/cm(2) in E-20. Animals in C-II and all experimental groups underwent surgical extraction of the mandibular left incisor followed by immediate placement of an osseointegrated implant (Nanotite(®), Biomet 3i(™)) into the socket. Animals in group C-I served as an absolute control for T3, T4, and calcium measurements. The level of significance was set at 5% (p≤0.05).
RESULTS:
ANOVA with Tukey's post-hoc test revealed significant differences in T3 and calcium levels among experimental groups, as well as significant within-group differences in T3, T4, and calcium levels over time.
CONCLUSIONS:
Although not reaching abnormal values, LLLT applied to the mandible influenced thyroid function in this model.
Methods: Protocols for the use of laser therapy in several clinical procedures are currently under investigation, as not all of the actions and systemic effects of laser irradiation have been clearly established.
Results: Forty male adult New Zealand rabbits were distributed across five groups of eight animals each: two control groups (C-I and C-II) of unirradiated animals, and three experimental groups (E-5, E-10, and E-20), each exposed to a distinct dose of gallium-aluminum-arsenide (GaAlAs) laser [λ=830 nm, 50 mW, continuous wave (CW)] every 48 h for a total of seven sessions. The total dose per session was 5 J/cm(2) in E-5, 10 J/cm(2) in E-10, and 20 J/cm(2) in E-20. Animals in C-II and all experimental groups underwent surgical extraction of the mandibular left incisor followed by immediate placement of an osseointegrated implant (Nanotite(®), Biomet 3i(™)) into the socket. Animals in group C-I served as an absolute control for T3, T4, and calcium measurements. The level of significance was set at 5% (p≤0.05).
Conclusions: ANOVA with Tukey's post-hoc test revealed significant differences in T3 and calcium levels among experimental groups, as well as significant within-group differences in T3, T4, and calcium levels over time.
Intro: The aim of this study was to assess the effects of low-level laser therapy (LLLT) applied to a dental extraction socket on thyroid gland function in a rabbit model, based on serum triiodothyronine and thyroxine levels. Sixteen male New Zealand rabbits were randomly distributed into two groups: a control group (non-irradiated animals) and an experimental group (irradiated animals: one irradiation point in the extraction socket of the lower incisor). Animals in the experimental group were irradiated with an aluminium gallium arsenide diode laser (AlGaAs; wavelength 830 nm, 40 mW, CW laser), for 13 days, every 48 h, at a dose of 6 J/cm(2) per session, resulting in a total dose of 42 J/cm(2). Serum triiodothyronine and thyroxine levels were measured in both groups before extraction and on the last day of observation (day 15). There were no statistically significant differences between the groups in pre- and post-irradiation triiodothyronine and thyroxine values. With the irradiation protocol used in this study, LLLT did not affect thyroid function in rabbits as assessed by circulating serum triiodothyronine and thyroxine levels.
Background: The aim of this study was to assess the effects of low-level laser therapy (LLLT) applied to a dental extraction socket on thyroid gland function in a rabbit model, based on serum triiodothyronine and thyroxine levels. Sixteen male New Zealand rabbits were randomly distributed into two groups: a control group (non-irradiated animals) and an experimental group (irradiated animals: one irradiation point in the extraction socket of the lower incisor). Animals in the experimental group were irradiated with an aluminium gallium arsenide diode laser (AlGaAs; wavelength 830 nm, 40 mW, CW laser), for 13 days, every 48 h, at a dose of 6 J/cm(2) per session, resulting in a total dose of 42 J/cm(2). Serum triiodothyronine and thyroxine levels were measured in both groups before extraction and on the last day of observation (day 15). There were no statistically significant differences between the groups in pre- and post-irradiation triiodothyronine and thyroxine values. With the irradiation protocol used in this study, LLLT did not affect thyroid function in rabbits as assessed by circulating serum triiodothyronine and thyroxine levels.
Low-level laser in the treatment of patients with hypothyroidism induced by chronic autoimmune thyroiditis: a randomized, placebo-controlled clinical trial.
Höfling DB1, Chavantes MC, Juliano AG, Cerri GG, Knobel M, Yoshimura EM, Chammas MC. - Lasers Med Sci. 2013 May;28(3):743-53. doi: 10.1007/s10103-012-1129-9. Epub 2012 Jun 21. (Publication) 1235 These findings suggest that LLLT was effective at improving thyroid function, promoting reduced TPOAb-mediated autoimmunity and increasing thyroid echogenicity in patients with CAT hypothyroidism.
Intro: Chronic autoimmune thyroiditis (CAT) is the most common cause of acquired hypothyroidism, which requires lifelong levothyroxine replacement therapy. Currently, no effective therapy is available for CAT. Thus, the objective of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in patients with CAT-induced hypothyroidism by testing thyroid function, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and ultrasonographic echogenicity. A randomized, placebo-controlled trial with a 9-month follow-up was conducted from 2006 to 2009. Forty-three patients with a history of levothyroxine therapy for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (830 nm, output power of 50 mW, and fluence of 707 J/cm(2); L group, n=23) or 10 sessions of a placebo treatment (P group, n=20). The levothyroxine was suspended 30 days after the LLLT or placebo procedures. Thyroid function was estimated by the levothyroxine dose required to achieve normal concentrations of T3, T4, free-T4 (fT4), and thyrotropin after 9 months of postlevothyroxine withdrawal. Autoimmunity was assessed by measuring the TPOAb and TgAb levels. A quantitative computerized echogenicity analysis was performed pre- and 30 days postintervention. The results showed a significant difference in the mean levothyroxine dose required to treat the hypothyroidism between the L group (38.59 ± 20.22 μg/day) and the P group (106.88 ± 22.90 μg/day, P<0.001). Lower TPOAb (P=0.043) and greater echogenicity (P<0.001) were also noted in the L group. No TgAb difference was observed. These findings suggest that LLLT was effective at improving thyroid function, promoting reduced TPOAb-mediated autoimmunity and increasing thyroid echogenicity in patients with CAT hypothyroidism.
Background: Chronic autoimmune thyroiditis (CAT) is the most common cause of acquired hypothyroidism, which requires lifelong levothyroxine replacement therapy. Currently, no effective therapy is available for CAT. Thus, the objective of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in patients with CAT-induced hypothyroidism by testing thyroid function, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and ultrasonographic echogenicity. A randomized, placebo-controlled trial with a 9-month follow-up was conducted from 2006 to 2009. Forty-three patients with a history of levothyroxine therapy for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (830 nm, output power of 50 mW, and fluence of 707 J/cm(2); L group, n=23) or 10 sessions of a placebo treatment (P group, n=20). The levothyroxine was suspended 30 days after the LLLT or placebo procedures. Thyroid function was estimated by the levothyroxine dose required to achieve normal concentrations of T3, T4, free-T4 (fT4), and thyrotropin after 9 months of postlevothyroxine withdrawal. Autoimmunity was assessed by measuring the TPOAb and TgAb levels. A quantitative computerized echogenicity analysis was performed pre- and 30 days postintervention. The results showed a significant difference in the mean levothyroxine dose required to treat the hypothyroidism between the L group (38.59 ± 20.22 μg/day) and the P group (106.88 ± 22.90 μg/day, P<0.001). Lower TPOAb (P=0.043) and greater echogenicity (P<0.001) were also noted in the L group. No TgAb difference was observed. These findings suggest that LLLT was effective at improving thyroid function, promoting reduced TPOAb-mediated autoimmunity and increasing thyroid echogenicity in patients with CAT hypothyroidism.
Abstract: Abstract
Chronic autoimmune thyroiditis (CAT) is the most common cause of acquired hypothyroidism, which requires lifelong levothyroxine replacement therapy. Currently, no effective therapy is available for CAT. Thus, the objective of this study was to evaluate the efficacy of low-level laser therapy (LLLT) in patients with CAT-induced hypothyroidism by testing thyroid function, thyroid peroxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb), and ultrasonographic echogenicity. A randomized, placebo-controlled trial with a 9-month follow-up was conducted from 2006 to 2009. Forty-three patients with a history of levothyroxine therapy for CAT-induced hypothyroidism were randomly assigned to receive either 10 sessions of LLLT (830 nm, output power of 50 mW, and fluence of 707 J/cm(2); L group, n=23) or 10 sessions of a placebo treatment (P group, n=20). The levothyroxine was suspended 30 days after the LLLT or placebo procedures. Thyroid function was estimated by the levothyroxine dose required to achieve normal concentrations of T3, T4, free-T4 (fT4), and thyrotropin after 9 months of postlevothyroxine withdrawal. Autoimmunity was assessed by measuring the TPOAb and TgAb levels. A quantitative computerized echogenicity analysis was performed pre- and 30 days postintervention. The results showed a significant difference in the mean levothyroxine dose required to treat the hypothyroidism between the L group (38.59 ± 20.22 μg/day) and the P group (106.88 ± 22.90 μg/day, P<0.001). Lower TPOAb (P=0.043) and greater echogenicity (P<0.001) were also noted in the L group. No TgAb difference was observed. These findings suggest that LLLT was effective at improving thyroid function, promoting reduced TPOAb-mediated autoimmunity and increasing thyroid echogenicity in patients with CAT hypothyroidism.
Intro: Local irradiation with pulsed (1500 Hz) low-energy infrared laser light of the thymus and thyroid gland region caused well-apparent stimulation of alpha-1-thymosin production in the healthy animals and normalized its level in the stressed ones. Similar stimulation of alpha-1-timosine biosynthesis was observed in an experiment with direct laser irradiation of the cultured HTSC epitheliocytes from the human thymus.
Background: Local irradiation with pulsed (1500 Hz) low-energy infrared laser light of the thymus and thyroid gland region caused well-apparent stimulation of alpha-1-thymosin production in the healthy animals and normalized its level in the stressed ones. Similar stimulation of alpha-1-timosine biosynthesis was observed in an experiment with direct laser irradiation of the cultured HTSC epitheliocytes from the human thymus.
Abstract: Abstract
Local irradiation with pulsed (1500 Hz) low-energy infrared laser light of the thymus and thyroid gland region caused well-apparent stimulation of alpha-1-thymosin production in the healthy animals and normalized its level in the stressed ones. Similar stimulation of alpha-1-timosine biosynthesis was observed in an experiment with direct laser irradiation of the cultured HTSC epitheliocytes from the human thymus.
Intro: Chronic autoimmune thyroiditis (CAT) remains the most common cause of acquired hypothyroidism. There is currently no therapy that is capable of regenerating CAT-damaged thyroid tissue. The objective of this study was to gauge the value of applying low-level laser therapy (LLLT) in CAT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies.
Background: Chronic autoimmune thyroiditis (CAT) remains the most common cause of acquired hypothyroidism. There is currently no therapy that is capable of regenerating CAT-damaged thyroid tissue. The objective of this study was to gauge the value of applying low-level laser therapy (LLLT) in CAT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies.
Abstract: Abstract
BACKGROUND AND OBJECTIVES:
Chronic autoimmune thyroiditis (CAT) remains the most common cause of acquired hypothyroidism. There is currently no therapy that is capable of regenerating CAT-damaged thyroid tissue. The objective of this study was to gauge the value of applying low-level laser therapy (LLLT) in CAT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies.
STUDY DESIGN/MATERIALS AND METHODS:
Fifteen patients who had hypothyroidism caused by CAT and were undergoing levothyroxine (LT4) treatment were selected to participate in the study. Patients received 10 applications of LLLT (830 nm, output power 50 mW) in continuous mode, twice a week, using either the punctual technique (8 patients) or the sweep technique (7 patients), with fluence in the range of 38-108 J/cm(2). USs were performed prior to and 30 days after LLLT. USs included a quantitative analysis of echogenicity through a gray-scale computerized histogram index (EI). Following the second ultrasound (30 days after LLLT), LT4 was discontinued in all patients and, if required, reintroduced. Triiodothyronine, thyroxine (T4), free T4, thyrotropin, thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) antibodies levels were assessed before LLLT and then 1, 2, 3, 6, and 9 months after LT4 withdrawal.
RESULTS:
We noted all patients' reduced LT4 dosage needs, including 7 (47%) who did not require any LT4 through the 9-month follow-up. The LT4 dosage used pre-LLLT (96 +/- 22 microg/day) decreased in the 9th month of follow-up (38 +/- 23 microg/day; P < 0.0001). TPOAb levels also decreased (pre-LLLT = 982 +/- 530 U/ml, post-LLLT = 579 +/- 454 U/ml; P = 0.016). TgAb levels were not reduced, though we did observe a post-LLLT increase in the EI (pre-LLLT = 0.99 +/- 0.09, post-LLLT = 1.21 +/- 0.19; P = 0.001).
CONCLUSION:
The preliminary results indicate that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for LT4, a reduction in TPOAb levels, and an increase in parenchymal echogenicity.
(c) 2010 Wiley-Liss, Inc.
Methods: Fifteen patients who had hypothyroidism caused by CAT and were undergoing levothyroxine (LT4) treatment were selected to participate in the study. Patients received 10 applications of LLLT (830 nm, output power 50 mW) in continuous mode, twice a week, using either the punctual technique (8 patients) or the sweep technique (7 patients), with fluence in the range of 38-108 J/cm(2). USs were performed prior to and 30 days after LLLT. USs included a quantitative analysis of echogenicity through a gray-scale computerized histogram index (EI). Following the second ultrasound (30 days after LLLT), LT4 was discontinued in all patients and, if required, reintroduced. Triiodothyronine, thyroxine (T4), free T4, thyrotropin, thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) antibodies levels were assessed before LLLT and then 1, 2, 3, 6, and 9 months after LT4 withdrawal.
Results: We noted all patients' reduced LT4 dosage needs, including 7 (47%) who did not require any LT4 through the 9-month follow-up. The LT4 dosage used pre-LLLT (96 +/- 22 microg/day) decreased in the 9th month of follow-up (38 +/- 23 microg/day; P < 0.0001). TPOAb levels also decreased (pre-LLLT = 982 +/- 530 U/ml, post-LLLT = 579 +/- 454 U/ml; P = 0.016). TgAb levels were not reduced, though we did observe a post-LLLT increase in the EI (pre-LLLT = 0.99 +/- 0.09, post-LLLT = 1.21 +/- 0.19; P = 0.001).
Conclusions: The preliminary results indicate that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for LT4, a reduction in TPOAb levels, and an increase in parenchymal echogenicity.
Intro: The aim of this study was to evaluate the effect of combined cyst aspiration and ultrasound-guided interstitial laser photocoagulation (ILP) on recurrence rate and the volume of benign cystic thyroid nodules. 10 euthyroid outpatients with a solitary and cytologically benign partially cystic thyroid nodule causing local discomfort were assigned to cyst aspiration followed by ultrasound-guided ILP and followed for 12 months. The ILP was performed under continuous ultrasound-guidance and with an output power of 2.5-3.5 W. The volume of the nodules was assessed by means of ultrasound and determination of the amount of aspirated cyst fluid, thereby calculating the volume of the solid part. Follow-up included ultrasound and determination of thyroid function. Pressure and cosmetic complaints were evaluated on a visual analogue scale. The median initial volume of the cystic nodule decreased from 9.6 ml [6.8;15.5 (quartiles)] to 3.5 ml [2.7;9.0 (quartiles)] (p = 0.0001), and the median cyst volume from 3.0 ml [2.0;6.0 (quartiles)] to 0 ml [0;0.5 (quartiles)] (p = 0.0001) during follow-up. Recurrence of the cystic part was defined as a cyst volume > 1 ml. In eight of 10 patients there was no recurrence of the cystic part. Both pressure symptoms and cosmetic complaints were significantly reduced. The only side effect was mild pain or tenderness for a few days. Our study suggests that complete cyst aspiration and subsequent ultrasound-guided ILP of benign cystic thyroid nodules is a feasible and safe technique, resulting in a significant reduction in the volume of both the solid and the cystic component. A large-scale prospective randomized study is warranted.
Background: The aim of this study was to evaluate the effect of combined cyst aspiration and ultrasound-guided interstitial laser photocoagulation (ILP) on recurrence rate and the volume of benign cystic thyroid nodules. 10 euthyroid outpatients with a solitary and cytologically benign partially cystic thyroid nodule causing local discomfort were assigned to cyst aspiration followed by ultrasound-guided ILP and followed for 12 months. The ILP was performed under continuous ultrasound-guidance and with an output power of 2.5-3.5 W. The volume of the nodules was assessed by means of ultrasound and determination of the amount of aspirated cyst fluid, thereby calculating the volume of the solid part. Follow-up included ultrasound and determination of thyroid function. Pressure and cosmetic complaints were evaluated on a visual analogue scale. The median initial volume of the cystic nodule decreased from 9.6 ml [6.8;15.5 (quartiles)] to 3.5 ml [2.7;9.0 (quartiles)] (p = 0.0001), and the median cyst volume from 3.0 ml [2.0;6.0 (quartiles)] to 0 ml [0;0.5 (quartiles)] (p = 0.0001) during follow-up. Recurrence of the cystic part was defined as a cyst volume > 1 ml. In eight of 10 patients there was no recurrence of the cystic part. Both pressure symptoms and cosmetic complaints were significantly reduced. The only side effect was mild pain or tenderness for a few days. Our study suggests that complete cyst aspiration and subsequent ultrasound-guided ILP of benign cystic thyroid nodules is a feasible and safe technique, resulting in a significant reduction in the volume of both the solid and the cystic component. A large-scale prospective randomized study is warranted.
Abstract: Abstract
The aim of this study was to evaluate the effect of combined cyst aspiration and ultrasound-guided interstitial laser photocoagulation (ILP) on recurrence rate and the volume of benign cystic thyroid nodules. 10 euthyroid outpatients with a solitary and cytologically benign partially cystic thyroid nodule causing local discomfort were assigned to cyst aspiration followed by ultrasound-guided ILP and followed for 12 months. The ILP was performed under continuous ultrasound-guidance and with an output power of 2.5-3.5 W. The volume of the nodules was assessed by means of ultrasound and determination of the amount of aspirated cyst fluid, thereby calculating the volume of the solid part. Follow-up included ultrasound and determination of thyroid function. Pressure and cosmetic complaints were evaluated on a visual analogue scale. The median initial volume of the cystic nodule decreased from 9.6 ml [6.8;15.5 (quartiles)] to 3.5 ml [2.7;9.0 (quartiles)] (p = 0.0001), and the median cyst volume from 3.0 ml [2.0;6.0 (quartiles)] to 0 ml [0;0.5 (quartiles)] (p = 0.0001) during follow-up. Recurrence of the cystic part was defined as a cyst volume > 1 ml. In eight of 10 patients there was no recurrence of the cystic part. Both pressure symptoms and cosmetic complaints were significantly reduced. The only side effect was mild pain or tenderness for a few days. Our study suggests that complete cyst aspiration and subsequent ultrasound-guided ILP of benign cystic thyroid nodules is a feasible and safe technique, resulting in a significant reduction in the volume of both the solid and the cystic component. A large-scale prospective randomized study is warranted.