A Evaluation of High Intensity Focused Ultrasound (HIFU) in the Treatment of Relapsed Graves' Disease

Inclusion Criteria: * age older than 18 years; * relapsed Graves' disease despite an adequate ATD treatment for 18 months or more; * HIFU accessibility of the targeted area (distance between the skin and the anterior surface of the nodule less than 10 mm; with no interference of the collarbone with HIFU unit movements); * normal thyrotropin concentration before procedure; * on at least 2-week of β-blockade prior to HIFU; and * absence of vocal cord immobility at laryngoscopy. Exclusion Criteria: * patients who prefer or indicated for surgery; * head and/or neck disease preventing hyperextension of the neck; * history of thyroid cancer or other malignant tumors in the neck region; * history of neck irradiation; * severe Grave's ophthalmopathy (GO); * large compressive goiter; * pregnancy or lactation; and * any contraindication related to intravenous moderate sedation.