Abstract
Purpose: To evaluate the effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules in pediatric patients.Materials and Methods: Twelve pediatric patients (11 female, 1 male; mean age 15.54 ± 2.8 years, range 10–19 years) with benign thyroid nodules (mean longest diameter 4.1 ± 1.4 cm, range 1.5–5.9 cm) treated by RFA from 2017 to 2020 were evaluated. The inclusion criteria for RFA therapy were (i) age < 20 years; (ii) benign cytological confirmation by 2 separate ultrasound guided fine-needle aspiration cytology (FNAC) or core needle biopsies; (iii) pressure symptoms or cosmetic problems caused by thyroid nodules; (iv) absence of any sonographic suspicious feature; and (v) follow-up for >6 months. Under local anesthesia, RFA was performed with the use of an RF generator and an 18-gauge internally cooled electrode. Volume changes in nodules on follow-up ultrasonography (US), changes in symptomatic and cosmetic scores, and complications arising during or after RFA were evaluated.Results: Mean follow-up period was 24.9 ± 13.9 months (range 6–43 months). At the last follow-up visits, volume of the nodule had decreased significantly (15.34 ± 11.52 mL vs. 4.07 ± 4.99 mL; P < 0.05), whereas volume reduction rate was 74.31% ± 19.59%. Both cosmetic and compressive symptoms were also significantly improved (2.91 ± 0.79 vs. 0.92 ± 0.67 and 1.5 ± 1.93 vs. 0.17 ± 0.39; P < 0.05). The mean number of ablation sessions was 1.4 ± 0.6 (range 1–3 sessions), and one of the patients suffered from transient vocal cord palsy which was spontaneously resolved 53 days later.Conclusions: RFA is a safe and effective treatment for benign thyroid nodules in pediatric patients, and can thus serve as an alternative treatment for thyroidectomy.
Highlights
Thyroid nodules are commonly diagnosed in adults, they affect only 1–2% of the pediatric population based on clinical examinations [1]
An alternative therapy to manage symptomatic pediatric benign goiters, while further studies should be conducted in the future
Several goiter characteristics may be associated with incomplete treatment and early regrowth of thyroid RFA, such as goiter baseline volume, vascularity, anatomical relationship to the critical structure, and ill-defined nodule goiters [18]
Summary
Thyroid nodules are commonly diagnosed in adults, they affect only 1–2% of the pediatric population based on clinical examinations [1]. A thyroid growth spurt coinciding with menarche in females may contribute to a higher incidence of goiter during mid- to late-puberty stages [2, 3]. Pediatric patients who have undergone thyroidectomy have higher complication rates than adult patients (9.1 vs 6.3%; P < 0.01) [7]. Patients receiving total thyroidectomy early in life require lifelong hormone substitution; it has been reported that over 40% patients are not able to completely adhere to postoperative medications [8]. In patients followed for more than 1 year, 40% reported psychological or behavioral problems and concomitant abnormal thyroid function, suggesting clinically evident hypothyroidism [8]. As traditional total thyroidectomy causes visible scarring at the anterior neck, patients could experience dermatologic symptoms such as pruritus, skin tightness, and pain, which negatively impact quality of life [10]
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