Treatment Of Thyroid Nodules Research Articles

Radiofrequency ablation of Bethesda category III thyroid nodules with benign molecular testing: Preliminary findings from a single institution

BackgroundThe efficacy of radiofrequency ablation (RFA) in treating thyroid nodules with indeterminate cytology remains less studied. The objective of this study was to determine the efficacy of RFA in treating nodules with Bethesda III that have been molecularly profiled benign (BIII-MPN). MethodsWe included prospectively enrolled patients who underwent RFA for benign and BIII-MPN thyroid nodules. Primary outcome measures were volume reduction ratio (VRR), symptom score (range 0–10), and cosmetic score (range 0–3) at 1, 3, 6, and 12 months after RFA, as well as complication rates. ResultsA total of 258 nodules in 192 patients were included (benign: 238 in 174; BIII-MPN: 20 in 18). The median VRR differed insignificantly, whereas symptom and cosmetic score improvements were similar between two cohorts. BIII-MPN thyroid nodules were associated with lower rates of infection and temporary voice change. ConclusionOur preliminary findings suggest that RFA may be a feasible management option for BIII-MPN thyroid nodules. However, appropriate will be important to address the important risk of potentially missed malignancies.

Incomplete ablation of thyroid cancer: Achilles’ Heel?

BackgroundIn recent years, the incidence of thyroid nodules has increased significantly. There are various ways to treat thyroid nodules, and ablation therapy is one of the important ways to treat thyroid nodules. However, there are many complications and deficiencies in the current ablation treatment of thyroid nodules, especially the incomplete ablation of thyroid cancer nodules, which limits the further application of ablation technology.Case SummaryIn this paper, we report two cases of incomplete ablation of thyroid nodules, one of which underwent surgical treatment due to anxiety after ablation, and the postoperative pathology confirmed that there was still residual papillary thyroid carcinoma, and the other patient underwent an operation after ablation, but visited our medical institution again due to cervical lymph node metastasis in a short period of time, and after radical cervical lymph node dissection, pathology confirmed multiple cervical lymph node metastasis. Radionuclide therapy was performed after surgery, and two patients are currently receiving endocrine suppression therapy, and their condition is stable with no signs of recurrence.ConclusionThe incomplete ablation of thyroid cancer nodules limits the development of ablation therapy, making ablation treatment a double-edged sword. Guidelines and expert consensus can guide their development, but they need to evolve with the times, and a multidisciplinary diagnostic team can help screen the most suitable patients. Only by using this technology more standardly, using the most appropriate technology, and treating the most suitable patients, can benefit more and more patients.

Comparative efficacy and safety of radiofrequency ablation and microwave ablation in benign thyroid nodule treatment: a systematic review and meta-analysis.

Ultrasound-guided thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), has become one of the main options for treating benign thyroid nodules (BTNs). To assess the efficacy of thermal ablation of BTNs, we performed a systematic review and meta-analysis of relevant studies. A comprehensive search of MEDLINE, EMBASE, and COCHRANE databases was performed up to September 25, 2023, to identify studies directly comparing RFA and MWA for pathologically proven BTNs and reporting clinical outcomes and complications. Data extraction and quality assessment were independently performed by two radiologists according to PRISMA guidelines. The analysis yielded the serial volume reduction ratios (VRRs) of ablated nodules for up to 12 months, symptom and cosmetic scores, and complications. This analysis included nine studies with 1305 BTNs treated by RFA and 1276 by MWA. VRRs at 1 month, 3 months, and 6 months were similar between RFA and MWA, but RFA showed a significantly higher VRR (83.3%) than MWA (76.9%) at 12 months (p = 0.02). Complication rates showed no significant difference between the two methods. Symptom and cosmetic scores significantly decreased after ablation, without a significant difference between the methods. Subgroup analysis indicated a significantly higher VRR at 12 months for RFA than for MWA for less experienced investigators (≤ 10 years), but no significant difference for more experienced investigators (> 10 years). RFA and MWA are both effective and safe methods for treating BTNs. RFA showed a higher VRR at 12 months and seems more suitable for less experienced investigators. RFA and MWA are both effective and safe treatments for BTNs, with RFA showing a higher VRR at 12 months. Both methods offer minimally invasive and reliable treatment for thyroid nodules. The most effective thermal ablation technique for BTNs remains undetermined. RFA showed a higher VRR at 12 months than MWA. Both techniques are effective for treating thyroid nodules; RFA offers greater benefits, particularly for less experienced investigators.

A Multi-dimensional Data Mining-based Study on the Prescriptions Developed by Professor Xu Zhiyin in Treating Thyroid Nodules.

In this study, we employed a multi-dimensional data mining approach to examine the clinical instances where Professor Xu Zhiyin treated thyroid nodules. Our aim is to understand the patterns of symptoms, underlying causes, and treatment approaches used for thyroid nodules. By doing so, the intention is to distill the essential aspects, compile Professor Xu Zhiyin's clinical insights, and investigate his scholarly perspectives. Professor Xu Zhiyin's clinical diagnoses and treatments spanning from 2009 to 2019 were entered into Microsoft Excel. Subsequently, the collected data was imported into the Medcase V5.2 system to facilitate data mining. Various techniques, such as frequency-based method, association rule analysis, and clustering, including a decentralized system clustering approach, were employed on a set of 346 cases involving patients with thyroid nodules that conformed to the specified criteria. The primary focus was on extracting insights regarding symptoms and the underlying causes from the medical records. By integrating these findings with Professor Xu Zhiyin's clinical expertise, we examined and summarized the outcomes of the data mining process. The fundamental prescriptions were successfully extracted using the techniques for mining across multiple dimensions. Utilizing the scattered grouping of these prescriptions and with reference to the cluster analysis of the frequency-linked system, the fundamental prescriptions proposed by Professor Xu Zhiyin for addressing thyroid nodules encompass the following ingredients: Glycyrrhiza uralensis Fisch, Cortex Moutan, Paeoniae radix rubra, Curcuma longa L., Radix Curcumae, persica seed, Citri Reticulatae Viride Pericarpium, Pinellia ternata, Spica Prunellae, Ostreae concha, Gleditsia sinensis spine, Tuckahoe and Radix Codonopsis. The fundamental prescriptions were acquired using the frequency approach, association rule technique, k-means clustering approach, and systematic clustering approach. The research findings corroborate one another, demonstrating that Professor Xu Zhiyin's approach to distinguishing and treating thyroid nodules is embodied in distinct prescriptions tailored to specific diseases.

Preference Phenotypes in Thyroid Nodule Management: A Patient Segmentation Approach.

Patient preferences regarding thyroid nodules are poorly understood. Our objective is to (1) employ a discrete choice experiment (DCE) to explore risk tradeoffs in thyroid nodule management, and (2) segment respondents into preference phenotypes. DCE. Thyroid surgery clinic, online survey. A DCE including 5 attributes (cancer risk, voice concerns, incision/scar, medication requirement, follow-up frequency) was refined with qualitative patient and physician input. A final DCE including 8 choice tasks, demographics, history, and risk tolerance was administered to participants with and without thyroid disease. Analysis was performed with multinomial logit modeling and latent class analysis (LCA) for preference phenotyping. A total of 1026 respondents were included; 480 had thyroid disease. Risk aversion was associated with increasing age (P < .001), female gender (P < .001), and limited education (P = .038), but not previous thyroid disease. Cancer risk most significantly impacted decision-making. Of the total possible utility change from thyroid nodule decision-making, 47.8% was attributable to variations in cancer risk; 20.0% from medication management; 14.9% from voice changes; 12.7% from incision/scar; and 4.6% from follow-up concerns. LCA demonstrated 3 classes with distinct preference phenotypes: the largest group (64.2%) made decisions primarily based on cancer risk; another group (18.2%) chose based on aversion to medication; the smallest group (17.7%) factored in medication and cancer risk evenly. Cancer risk and the need to take medication after thyroid surgery factor into patient decision-making most heavily when treating thyroid nodules. Distinct preference phenotypes were demonstrated, reinforcing the need for individual preference assessment before the treatment of thyroid disorders.

Traditional Chinese medicine treatment for benign thyroid nodules: Literature review.

Thyroid nodules (TNs) are pathological changes characterized by abnormal proliferation of thyroid gland tissue. Approximately 19% to 67% of asymptomatic individuals are diagnosed with TNs, with the majority being benign nodules and 4% to 6.5% being thyroid cancer nodules. Western medicine recommends regular examinations and surgery, while traditional Chinese medicine (TCM) provides an alternative choice to maintain thyroid function and reduce the need for surgery. However, in Taiwan, research on TCM treatment for benign TNs is primarily limited to case reports, lacking large-scale and systematic clinical studies. We conducted a search of electronic databases including PubMed, Google Scholar, Wanfang Data, and China National Knowledge Infrastructure to collect clinical trials related to TCM treatment for TNs. Our goal is to provide new treatment options, further validate the value of TCM in the treatment of TNs, and lay a foundation for future clinical research.

Thyroid Nodules: Emerging Trends in Detection and Visualization based on Citespace.

Thyroid nodule (TN) is a highly prevalent clinical endocrine disease. Many countries have formed guidelines on the prevention and treatment of TN based on extensive research. However, there is a scarcity of TN-related literature based on bibliometrics. This study aimed to evaluate the scientific achievements and progress of TN research from a global perspective by investigating the literature for 20 years through bibliometrics. We searched the literature on TN in the core collection of the Web of Science database from 2002 to 2021 and used the Citespace software to analyze the co-authorship, co-citation, and co-occurrence of countries, institutions, authors, keywords, and co-cited literature. We retrieved 12319 documents related to TN. The literature on TN has been growing since 2002. The United States has contributed the largest proportion of TN papers (20.64%), followed by China, Italy, and South Korea. The United States ranked first in terms of centrality (0.38). Haugen BR, Gharib H, and Cibas ES are the top three most cited authors. The papers published in Thyroid were cited most frequently (7952 times). The most prominent keywords were management, cancer, fine needle aspiration, diagnosis, malignant tumor, thyroid cancer, ultrasound, biopsy, benign, surgery, ablation, and cytology. All keywords could be divided into three categories: diagnosis stratification, treatment, and cancer. As far as potential hot spots are concerned, the keywords that have recently burst strongly and are still continuing are: "Association Guideline" (2018-2021), "Radiofrequency Ablation" (2017-2021), "Classification" (2019-2021), and "Data System" (2017-2021). Based on the current trends, the number of publications on TN will continue to increase. The United States is the most active contributor to research in this field. Previous literature focused on stratification, cancer, surgery, and ablation, and there were different opinions on the stratification of diagnosis. There were relatively few studies on pathogenesis and treatment using medicine. More focus will be placed on association guidelines, radiofrequency ablation, classification, and data system, which may be the next popular topics in TN research.

Professor Song Zongliang's Experience in Treating Thyroid Nodules with "Wood Suppression and Soil Support Method"

Professor Song Zongliang's Experience in Treating Thyroid Nodules with "Wood Suppression and Soil Support Method"

SAT497 Radiofrequency Ablation of Thyroid Cancer in A Patient With Steinert’s Disease

Abstract Disclosure: A.P. Solis Pazmiño: None. M. Arboleda Carvajal: None. R. Godoy: None. C. Garcia: None. Background: Radiofrequency Ablation (RFA) is a non-surgical, minimally invasive technique for benign or microcarcinoma thyroid nodule (TN); and it has emerged as an alternative option for patients deemed at high risk for surgery. Steinert’s Disease or Myotonic dystrophy type 1 (DM1) is a genetic multisystem disease that affects almost all organs and tissues, including the thyroid. In these patients the prevalence of TN is increased, regardless they are benign or malignant. Patients with DM1 commonly have post-anesthetic complications such as cardiorespiratory arrest. Clinical Case: A young man diagnosed with DM1 and no other comorbidities came to the office for a TN. The patient was asymptomatic and had normal thyroid function. Nothing relevant was found on physical examination, and no cervical lymph nodules were found. The thyroid ultrasonography (US) showed a 12x11x13 mm solid isoechoic left lobe nodule, with microcalcifications, irregular borders and the color-flow Doppler US detected increased perfusion, classifying it as a TI-RADS 5 nodule, elastography score of 2.2, and Bethesda VI. Due to DM1 high risk of surgery, the patient underwent RFA with no complications and successful recovery. Results: At the first month follow-up after RFA, the thyroid nodule was fibrosed with a size of 10x14x15 mm and with a volume of 1,11 cc. The thyroid function was normal without late complications. Conclusions: RFA is a non-invasive and effective technique for the treatment of benign and malignant TN. It is safe and very useful in cases where surgery is contraindicated or in patients with a high probability of post-surgical or post-anesthetic complications. Data on a longer follow-up are needed to confirm long-term efficacy. Presentation Date: Saturday, June 17, 2023

Creation of indications for interstitial laser photocoagulation of thyroid nodules

Relevance. Minimally invasive interventions under ultrasound control are a promising method for treating thyroid nodules with proven clinical effects. Indications for the use of minimally invasive methods are constantly changing and being supplemented. It is of practical interest to expand the indications for interstitial laser photocoagulation of thyroid nodes as experience accumulates. The purpose of the study: to study the changes in indications for performing interstitial laser photocoagulation of thyroid nodes over 15 years.Materials and methods. Based on the experience of treating 876 patients with colloidal goiter using interstitial laser photocoagulation, the dynamics of indications for this technique were studied. The treatment data were analyzed in two-time groups: group 1 — the initial stage of the introduction of the technique, and group 2 — the stage of widespread use of the technique. With the accumulation of experience, the adjustment of photocoagulation and ultrasound modes was carried out. The control of the treatment was evaluated in dynamics by reducing the volume of nodes.Results and conclusions. During the study, it was found that in both groups of patients, it was possible to achieve regression and decrease in the size of the nodes, depending on the pathology and size of the nodes. This made it possible to expand the indications at the expense of patients with large nodes (more than 30 mm in diameter). With recurrent nodular goiter, good results were also obtained. It has been established that interstitial laser photocoagulation is a safe, predictable method of treatment with the possibility of selecting individual regimens, well tolerated by patients. Indications for the use of the method are wide and are set individually based on the predicted risk/effectiveness ratio. The method does not negatively affect the quality of life of patients. When selecting patients, the opinion of both the doctor and patient should be taken into account.

Development and validation of the nomogram based on ultrasound, thyroid stimulating hormone, and inflammatory marker in papillary thyroid carcinoma: a case-control study.

The increase in the number of thyroid cancer cases in recent years has increased not only the medical burden but also the potential for overtreatment. Therefore, it is crucial to distinguish papillary thyroid cancer from benign thyroid nodules before surgery when treating thyroid nodules. The patients were divided into two groups: 117 patients made up the validation cohort and 414 patients made up the primary cohort. As a result of the primary cohort, a preoperative prediction model was developed, which was then validated externally in the validation cohort. Preoperative thyrotropin (thyroid stimulating hormone, TSH), systemic immune-inflammation index (SII), lymphocyte-to-monocyte ratio (LMR), and ultrasonographic features were recorded in both groups. As predictors for the model, the preoperative blood levels of TSH, SII, LMR, echogenicity, margin, calcification, composition, taller-than-wide, and age were chosen. This was the regression equation: Y = -0.070 × (age) + 1.511 × (echogenicity) + 1.664 × (margin) + 1.003 × (calcification) + 0.939 × (composition) + 2.964 × (tall than wide) + 0.305 × (TSH) + 0.558 × (SII) - 1.271 × (LMR) + 0.327. Papillary thyroid carcinoma (PTC) was predicted positively with values of Y ≥0.808. The prediction model's accuracy, sensitivity, and specificity were 88.2%, 85.1%, and 94.9%, respectively. The area under the receiver operating characteristic (ROC) curve was 0.961. The model's external validation produced satisfactory results with accuracy, sensitivity, and specificity of 85.5%, 90.9%, and 75.5%, respectively. Using the preoperative TSH, SII, LMR, and ultrasonographic characteristics, a straightforward and accurate preoperative prediction model for PTC has been developed and validated. The preoperative assessment of PTC in clinical application is enhanced by this approach.

A Case Challenge: Differentiating Thyroid Nodules for Malignancy and Management

An increase in the identification of thyroid nodules (TNs) leads to a subsequent increase in benign nodules being misdiagnosed as malignant. The American Thyroid Association has recognized that most TNs are benign and has developed clinical guidelines to guide clinical decision making for the reduction of excessive thyroidectomy. Evaluation and treatment of TNs is recommended for all nodules identified through palpation and incidentally through advanced imaging. The goal of evaluation is to initiate accurate monitoring and management recommendations based on malignancy risk determined by patient history, physical examination, ultrasound imaging, and fine-needle aspiration biopsy when indicated.

Preliminary study on CT contrast-enhanced radiomics for predicting central cervical lymph node status in patients with thyroid nodules.

To explore the feasibility of using a contrast-enhanced CT image-based radiomics model to predict central cervical lymph node status in patients with thyroid nodules. Pretreatment clinical and CT imaging data from 271 patients with surgically diagnosed and treated thyroid nodules were retrospectively analyzed. According to the pathological features of the thyroid nodules and central lymph nodes, the patients were divided into three groups: group 1: papillary thyroid carcinoma (PTC) metastatic lymph node group; group 2: PTC nonmetastatic lymph node group; and group 3: benign thyroid nodule reactive lymph node group. Radiomics models were constructed to compare the three groups by pairwise classification (model 1: group 1 vs group 3; model 2: group 1 vs group 2; model 3: group 2 vs group 3; and model 4: group 1 vs groups (2 + 3)). The feature parameters with good generalizability and clinical risk factors were screened. A nomogram was constructed by combining the radiomics features and clinical risk factors. Receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were performed to assess the diagnostic and clinical value of the nomogram. For radiomics models 1, 2, and 3, the areas under the curve (AUCs) in the training group were 0.97, 0.96, and 0.93, respectively. The following independent clinical risk factors were identified: model 1, arterial phase CT values; model 2, sex and arterial phase CT values; model 3: none. The AUCs for the nomograms of models 1 and 2 in the training group were 0.98 and 0.97, respectively, and those in the test group were 0.95 and 0.87, respectively. The AUCs of the model 4 nomogram in the training and test groups were 0.96 and 0.94, respectively. Calibration curve analysis and DCA revealed the high clinical value of the nomograms of models 1, 2 and 4. The nomograms based on contrast-enhanced CT images had good predictive efficacy in classifying benign and malignant central cervical lymph nodes of thyroid nodule patients.

Non-surgical treatment of benign thyroid nodules Worldwide and Saudi Arabia

Thyroid nodules (TNs) are a widespread occurrence among adults across the world. While most of the nodules are asymptomatic and only require follow-ups and monitoring by a physician, some nodules grow and cause symptoms associated with cosmetic concerns and pressure in the neck region. However, there is mounting evidence of non-surgical thermal ablation (NSTA) methods for treating benign TNs. Although some medical centers in Saudi Arabia practice such treatment modalities for TNs, studies from these centers have not been conducted comparing the efficacy and cost-effectiveness between conventional surgical treatment and NSTA. In this review article, our main objective was to review the current literature, show the efficacy and affordability of NSTA treatment of TNs worldwide, and compare it to Saudi Arabia&amp;apos;s data. This included a review of various NSTA techniques, associated cost implications, pre-treatment and pre-qualification procedures, post-treatment and follow-ups, and the side effects. Clinical review publications related to the non-surgical treatment of TNs were selected. The focus was on large-scale, randomized studies, publications by certified national or international thyroid associations, and peer-reviewed articles on various medical websites such as PubMed. Search criteria were based on keywords: thyroid nodules, thermal ablation, laser ablation, radiofrequency high-intensity focused ultrasound, microwaves, and European Thyroid Association. This study first identified and scrutinized 65 articles from sources such as PubMed and Research Gate and applied the selection, inclusion, and exclusion criteria to narrow down to the final 30 articles that were more relevant to the study area.

Cost comparison between open thyroid lobectomy and radiofrequency ablation for management of thyroid nodules.

There is an increasing array of treatment options for addressing clinically significant thyroid nodules, including radiofrequency ablation (RFA). While effective, the cost compared to alternative approaches has not been well elucidated. This study involved a retrospective chart review, focusing on variable direct cost (VDC) of each procedure, from April 2016 to January 2020. We analyzed costs for 53 open lobectomies and 16 RFA procedures. Cost effectiveness depended on the simulated cost of the RFA probe. In comparison to open lobectomy, the VDC to perform RFA was $597 (19%) cheaper when the simulated probe cost was $1500 and $403 (13%) more expensive for a probe cost of $2500. Statistical significance was achieved for both these differences. If cost per RFA probe can be less than $2100-the break-even dollar amount between open lobectomy and RFA-there would be considerable cost savings for treating thyroid nodules.

Radiofrequency ablation for benign thyroid nodule treatment: New solution in our center.

Introduction and importanceThyroid nodules are one of the most common thyroid disorders and are estimated at 4–7 % in the general population. Although it is estimated that 95 % of thyroid nodules are benign and only 4.0–6.5 % malignant, a combined assessment of clinical data, ultrasound imaging, and FNAB is needed to estimate the risk of malignancy. Several minimally invasive nonsurgical modalities have been developed to treat thyroid nodules, including ethanol ablation (EA), laser ablation (LA), microwave ablation (MWA), and radiofrequency ablation (RFA). Since 2006, this method had been used to treat thyroid nodules and reported to have good efficacy and safety for treating benign thyroid nodules and recurrent thyroid cancer. This paper aims to provide the efficacy and safety of the RFA procedure in benign thyroid lesions.Case presentationsHere we report 34 cases of patients with thyroid nodules who underwent RFA procedures. After the procedure, patients were followed up in the first, third, sixth, and twelfth months. The ratio of decreasing volume in the first, third, sixth, and twelfth months was as follows 81.6 %; 76.89 %; 63.48 %, 60.11 %.Clinical discussionFactors that are thought to predict RFA response include small volume nodule (<12 ml), the presence of a fluid component and well-defined margins, the absence of vascularization, and nonfunctioning status. However, RFA has several limitations, including the procedure that is highly operator dependent to maximize its efficacy, the possibility of persistent lesions, and the lack of a final histological diagnosis that does not completely exclude aggressive histological variants.ConclusionThe RFA procedure has minimal side effects, is highly effective, and is short in procedure time.

Predictors of Malignancy in Thyroid Nodules Classified as Bethesda Category III.

ObjectiveTo determine predictors of malignancy in surgically treated Bethesda category III nodules.MethodsPatients with surgically treated thyroid nodules classified as Bethesda category III were retrospectively enrolled. The association between clinical/sonographic features and postoperative pathology was evaluated using univariate and multivariate analyses.ResultsA total of 188 nodules from 184 patients were included. The overall malignancy rate was 54.3%. In univariate analysis, male sex, aspect ratio >1, microcalcification, unclear boundary, BRAFV600E mutation, and nuclear atypia were significantly associated with malignant disease in Bethesda category III nodules. Multivariate analysis confirmed that male sex, aspect ratio >1, microcalcification, and BRAFV600E mutation were independent predictors of malignant disease.ConclusionsMalignant disease was common in Bethesda category III nodules, and surgical treatment was strongly indicated in the presence of male sex, aspect ratio>1, microcalcification, and BRAFV600E mutation.

Minimalno invazivne metode za lečenje tiroidnih nodusa i karcinoma

Thyroid nodules (TN) are present in about half of the population. About 5% of all nodules are malignant. Image-guided methods for the treatment of TN are becoming a significant alternative to surgery. Percutaneous ethanol ablation (PEA) is effective in the treatment of thyroid cysts, and neck lymph node metastases. Percutaneous laser ablation (PLA) significantly reduces the size of the nodules and improves subjective symptoms. The adverse effects of PEA are rare, transitory, and mild. Radiofrequency ablation (RFA) is effective for nodules of all sizes and compositions. The major complications of RFA are rare and transient. Microwave ablation is also effective in the treatment of thyroid nodules with rare major complications. High-intensity focused ultrasound (HIFU) is a transcutaneous method. It is effective in the treatment of thyroid nodules, and complications are rare. Graves' hyperthyroidism was also treated with HIFU. As thermal ablation (TA ) methods are becoming more popular in 2020, the European Thyroid Association published clinical practice guidelines for the use of image-guided ablation in benign thyroid nodules. A meta-analysis showed that low-risk papillary thyroid microcarcinoma recurrences after TA treatment are rare, as are complications. As the TA methods are acceptable for the treatment of the low-risk papillary thyroid carcinoma European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe issued clinical practice guidelines for the use of minimally invasive treatments in malignant thyroid lesions. Image-guided treatments for thyroid nodules and cancer are here to stay. Their use will expand and become part of routine clinical practice.

Efficacy and Safety of Radio Frequency Ablation for Benign Thyroid Nodules: Initial Clinical Experience in United Arab Emirates

Abstract Objectives Radio frequency ablation (RFA) to treat thyroid nodules is well known as one of alternative therapeutic modalities. This study aimed to investigate the efficacy and complications of RFA to treat symptomatic benign thyroid nodules in United Arab Emirates. Materials and Methods Eight-nine benign thyroid nodules of 63 patients were enrolled, who were treated by percutaneous ultrasound (US)-guided RFA from 2017 to 2020, and had following US examinations during 12 months after RFA procedure. Symptomatic score with 10-cm visual scale, cosmetic score with four-point scale, and US findings (nodule diameter, volume, composition and vascularity) were compared before and after RFA procedures. RFA-related complications (hematoma, voice change, hypothyroidism, and hyperthyroidism) were assessed. Statistical Analysis Paired t test was applied to compare laboratory findings before and after RFA procedure. Multiple linear regression analysis was applied to determine significant factors to predict the efficacy of RFA. One-way analysis of variance was applied to compare volume reduction rate (VRR) at 3, 6, and 12 months. Results Symptomatic and cosmetic scores were significantly improved (pre-RFA vs. post-RFA; 6.07 ± 1.89 vs. 2.06 ± 1.09, 2.94 ± 0.84 vs. 1.27 ± 0.51, p&lt; 0.001). Nodule diameter (cm), volume (mL) at pre-RFA, post-RFA 3 months, 6 months, and 12 months were 3.86 ± 1.26, 2.64 ± 1.14, 2.06 ± 1.09, 1.82 ± 1.14, and 18.8 ± 18.79, 8.82 ± 12.42, 4.47 ± 5.59, 4.11 ± 9.17 (p&lt; 0.001). VRR (%) was 52.81 ± 23.48 at post-RFA 3 months, 79.77 ± 16.91 at 6 months, and 82.08 ± 19.54 at 12 months. Composition of solidity was a significant predictive factor, related to VRR at post-RFA 12 months (p = 0.003). Complication rate was 12.7% (8 of 63 patients). Major complications did not occur. Conclusion RFA can be an effective and safe alternative modality to treat benign thyroid nodules, and be preferable to treat symptomatic cystic thyroid nodules in Middle East population.

Chief Physician Wang Defen’s Experience in Treating Thyroid Nodules based on Syndrome Differentiation

To summarize the experience of Chief Physician Wang Defen in the treatment of thyroid nodules. According to many years of clinical experience, Chief Physician Wang Defen believes that the occurrence of thyroid nodules is mostly affected by emotional factors. Qi stagnation, liver depression and fire, phlegm and Qi are the pathogenesis of the disease, which is closely related to liver Qi stagnation. Based on the basic treatment principle of Nourishing Yin, clearing heat, soothing liver and strengthening spleen, the prescription chose Danzhi Xiaoyao Powder plus or minus can often achieve good clinical efficacy.