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Outcomes of Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules: A Mayo Clinic Case Series

      Abstract

      Objective

      To assess the effectiveness, tolerability, and complications of radiofrequency ablation (RFA) in patients with benign large thyroid nodules (TNs).

      Patients and Methods

      This is a retrospective review of 14 patients with predominantly solid TNs treated with RFA at Mayo Clinic in Rochester, Minnesota, from December 1, 2013, through October 30, 2016. All the patients declined surgery or were poor surgical candidates. The TNs were benign on fine-needle aspiration, enlarging or causing compressive symptoms, and 3 cm or larger in largest diameter. We evaluated TN volume, compressive symptoms, cosmetic concerns, and thyroid function.

      Results

      Median TN volume reduction induced by RFA was 44.6% (interquartile range [IQR], 42.1%-59.3%), from 24.2 mL (IQR, 17.7-42.5 mL) to 14.4 mL (IQR, 7.1-19.2 mL) (P<.001). Median follow-up was 8.6 months (IQR, 3.9-13.9 months). Maximum results were achieved by 6 months. Radiofrequency ablation did not affect thyroid function. In 1 patient with subclinical hyperthyroidism due to toxic adenoma, thyroid function normalized 4 months after ablation of the toxic nodule. Compressive symptoms resolved in 8 of 12 patients (67%) and improved in the other 4 (33%). Cosmetic concerns improved in all 8 patients. The procedure had no sustained complications.

      Conclusion

      In this population, RFA of benign large TNs performed similarly to the reports from Europe and Asia. It induces a substantial volume reduction of predominantly solid TNs, improves compressive symptoms and cosmetic concerns, and does not affect normal thyroid function. Radiofrequency ablation has an acceptable safety profile and should be considered as a low-risk alternative to conventional treatment of symptomatic benign TNs.

      Abbreviations and Acronyms:

      CFD (color flow Doppler), IQR (interquartile range), RFA (radiofrequency ablation), SYS (symptom score), TN (thyroid nodule)
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      References

        • Tan G.H.
        • Gharib H.
        Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging.
        Ann Intern Med. 1997; 126: 226-231
        • Guth S.
        • Theune U.
        • Aberle J.
        • Galach A.
        • Bamberger C.M.
        Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.
        Eur J Clin Invest. 2009; 39: 699-706
        • Bergenfelz A.
        • Jansson S.
        • Kristoffersson A.
        • et al.
        Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients.
        Langenbeck Arch Surg. 2008; 393: 667-673
        • Haugen B.R.
        • Alexander E.K.
        • Bible K.C.
        • et al.
        2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.
        Thyroid. 2016; 26: 1-133
        • Kim Y.S.
        • Rhim H.
        • Tae K.
        • Park D.W.
        • Kim S.T.
        Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience.
        Thyroid. 2006; 16: 361-367
        • Cesareo R.
        • Pasqualini V.
        • Simeoni C.
        • et al.
        Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules.
        J Clin Endocrinol Metab. 2015; 100: 460-466
        • Faggiano A.
        • Ramundo V.
        • Assanti A.P.
        • et al.
        Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study.
        J Clin Endocrinol Metab. 2012; 97: 4439-4445
        • Spiezia S.
        • Garberoglio R.
        • Milone F.
        • et al.
        Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation.
        Thyroid. 2009; 19: 219-225
        • Gazelle G.S.
        • Goldberg S.N.
        • Solbiati L.
        • Livraghi T.
        Tumor ablation with radio-frequency energy.
        Radiology. 2000; 217: 633-646
        • Fukunari N.
        • Nagahama M.
        • Sugino K.
        • Mimura T.
        • Ito K.
        • Ito K.
        Clinical evaluation of color Doppler imaging for the differential diagnosis of thyroid follicular lesions.
        World J Surg. 2004; 28: 1261-1265
        • Zingrillo M.
        • Collura D.
        • Ghiggi M.R.
        • Nirchio V.
        • Trischitta V.
        Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection.
        J Clin Endocrinol Metab. 1998; 83: 3905-3907
        • Baek J.H.
        • Jeong H.J.
        • Kim Y.S.
        • Kwak M.S.
        • Lee D.
        Radiofrequency ablation for an autonomously functioning thyroid nodule.
        Thyroid. 2008; 18: 675-676
        • Jeong W.K.
        • Baek J.H.
        • Rhim H.
        • et al.
        Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients.
        Eur Radiol. 2008; 18: 1244-1250
        • Baek J.H.
        • Moon W.J.
        • Kim Y.S.
        • Lee J.H.
        • Lee D.
        Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules.
        World J Surg. 2009; 33: 1971-1977
        • Lim H.K.
        • Lee J.H.
        • Ha E.J.
        • Sung J.Y.
        • Kim J.K.
        • Baek J.H.
        Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients.
        Eur Radiol. 2013; 23: 1044-1049
        • Verloop H.
        • Louwerens M.
        • Schoones J.W.
        • Kievit J.
        • Smit J.W.
        • Dekkers O.M.
        Risk of hypothyroidism following hemithyroidectomy: systematic review and meta-analysis of prognostic studies.
        J Clin Endocrinol Metab. 2012; 97: 2243-2255
        • Stoll S.J.
        • Pitt S.C.
        • Liu J.
        • Schaefer S.
        • Sippel R.S.
        • Chen H.
        Thyroid hormone replacement after thyroid lobectomy.
        Surgery. 2009; 146 (discussion 558-560): 554-558
        • Steurer M.
        • Passler C.
        • Denk D.M.
        • Schneider B.
        • Niederle B.
        • Bigenzahn W.
        Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk.
        Laryngoscope. 2002; 112: 124-133
        • Barczynski M.
        • Konturek A.
        • Stopa M.
        • Cichon S.
        • Richter P.
        • Nowak W.
        Total thyroidectomy for benign thyroid disease: is it really worthwhile?.
        Ann Surg. 2011; 254: 724-730
        • Witt R.L.
        Recurrent laryngeal nerve electrophysiologic monitoring in thyroid surgery: the standard of care?.
        J Voice. 2005; 19: 497-500
        • Che Y.
        • Jin S.
        • Shi C.
        • et al.
        Treatment of benign thyroid nodules: comparison of surgery with radiofrequency ablation.
        AJNR Am J Neuroradiol. 2015; 36: 1321-1325
        • Berber E.
        • Bernet V.
        • Fahey III, T.J.
        • et al.
        American Thyroid Association statement on remote-access thyroid surgery.
        Thyroid. 2016; 26: 331-337
        • Huh J.Y.
        • Baek J.H.
        • Choi H.
        • Kim J.K.
        • Lee J.H.
        Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session—prospective randomized study.
        Radiology. 2012; 263: 909-916
        • Sim J.S.
        • Baek J.H.
        • Lee J.
        • Cho W.
        • Jung S.I.
        Radiofrequency ablation of benign thyroid nodules: depicting early sign of regrowth by calculating vital volume.
        Int J Hyperthermia. 2017; 33: 905-910

      Linked Article

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          I was fascinated to read the article by Iniguez-Ariza et al1 describing the Mayo Clinic experience with ethanol ablation for the treatment of cystic thyroid nodules. Although there is a very low risk of malignancy with cystic nodules, many patients who are symptomatic remain dissatisfied with the lack of nonsurgical therapeutic options because simple aspiration of the fluid content from the thyroid cyst often results in only short-term improvement.2 Ethanol ablation may be beneficial3 but is not currently performed in most medical centers.
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      • In Reply—Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules
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          To The Editor: We thank Park and Jung1 for their pertinent comments regarding our article.2 They emphasize the use of a transisthmic approach along with a moving-shot technique, both of which we have used, to achieve a safe and effective radiofrequency ablation (RFA) session. In addition, they describe the commonly used approach to anesthesia for RFA—perithyroidal lidocaine injection—and suggest that general anesthesia, as used by us, would not allow monitoring of voice changes during the procedure.
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      • Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules
        Mayo Clinic ProceedingsVol. 93Issue 9
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          To the Editor: We read with great interest a report by Hamidi et al,1 titled “Outcomes of Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules: A Mayo Clinic Case Series.” Hamidi et al1 presented a retrospective review of 14 patients with predominantly solid thyroid nodules (TNs) treated with radiofrequency ablation (RFA) at the Mayo Clinic. The authors achieved 44.6% of median volume reduction with 8.6 months of the median follow-up period. The clinical efficacy was proved by resolution of compressive symptoms and improvement of cosmetic concerns.
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