Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules.

Roberto Cesareo,Giuseppe Pelle,Carla Simeoni,Alessandro Casini,Giuseppe Campagna,Valerio Pasqualini,Silvia Manfrini,Roberto Cianni,Andrea Palermo

doi:10.1590/2359-3997000000246

Abstract

The objective of our study is to evaluate the clinical outcomes and safety of radiofrequency thermal ablation (RFA) for benign thyroid nodules (BTNs) over a 1-year follow-up. This is a monocentric retrospective study. Forty-eight patients with solid, non-functioning BTNs were treated by RFA using a 17G internally cooled electrode. We categorized thyroid nodules as small (≤ 12 mL), medium (12 to 30 mL), or large (over 30 mL). BTNs volume reduction, thyroid function, cosmetic and compressive score changes and side effect evaluation at 6 and 12 months were evaluated. BTN volume decreased significantly from baseline to 6 (mean percentage decrease of BTN volume was 66.8 ± 13.6%, p < 0.001). At 12 months, the mean percentage reduction of BTN volume compared to six months was 13.7 ± 17.1% (p < 0.001). At 6-month, symptom score had improved significantly (p < 0.001) while it does not change significantly between 6 and 12 months. In particular, symptom score improved significantly in the medium (p < 0.001) and large (p < 0.01) subgroups. Cosmetic score improved significantly between baseline and 6 months (p < 0.001) and between 6 and 12 months (p < 0.01). In all the subgroups, cosmetic score improved significantly between baseline and 6 months, while between 6 and 12 months it improved significantly only in the large group (p < 0.05). RFA was well tolerated. Only one patient experienced permanent right paramedian vocal cord palsy. A single RFA treatment was effective in reducing BTNs volume, in particular small and medium nodules. Cosmetic score improved in all treated BTNs while symptom score only got better in the medium and large BTNs.

Highlights

O ver the last decade, non-surgical minimally invasive US-guided debulking techniques have been proposed to reduce the volume of thyroid nodules when surgery is contraindicated or refused [1]
A single benign thyroid nodules (BTNs) volume was measured in case of uninodular goiter or in case of multinodular goiter when characterized by one predominant nodule associated with other non-clinically significant thyroid nodules
One patient experienced permanent right paramedian vocal cord palsy with inspiratory stridor without dysphonia. This one year retrospective study has demonstrated that one single radiofrequency ablation (RFA) treatment was effective in reducing benign non-functional thyroid nodules volume in particular small and medium nodules

Summary

INTRODUCTION

O ver the last decade, non-surgical minimally invasive US-guided debulking techniques have been proposed to reduce the volume of thyroid nodules when surgery is contraindicated or refused [1]. Our retrospective study aims to evaluate the clinical outcomes and safety of a single RFA treatment for benign non-functioning thyroid solid nodules over a 1-year follow-up. We categorized thyroid nodules in small (≤ 12 mL), medium (12 to 30 mL), or large (over 30 mL) and BTN volume reduction, thyroid function, cosmetic and compressive score changes and side effects were evaluated. 2 cm steadily growing over time; – Cytologically confirmed benign nodule on two separate US-guided FNAB; – Serum thyroid hormone (free T4 and free T3), thyrotropin levels (TSH), calcitonin, thyroid peroxidase and thyroglobulin antibodies within normal ranges; – No history of radioiodine therapy or thermal ablation; – No previous neck or trunk external beam radiotherapy; – Refusal of or ineligible for surgery; – One single RFA treatment. Morphologically evaluated at 6 and 12 months

Procedure

RESULTS

DISCUSSION