Abstract and Introduction
Abstract
Context: Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country.
Objective: To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States.
Methods: This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed.
Results: Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months.
Conclusion: RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
Introduction
Thyroid nodules (TNs) are common and with the advent of high-resolution ultrasonography techniques, are detected in up to ~68% of the general population in the United States.[1] Most nodules are benign and asymptomatic; however, ~5% to 15% can grow and cause compressive symptoms or cosmetic issues, with palpable nodules being 5 times more prevalent in females compared with males.[2–4] In addition, ~5% to 10% of TNs are autonomously functioning and can result in symptoms or biochemical subclinical or overt hyperthyroidism.[3–5] The standard of care for symptomatic, benign, nonfunctioning thyroid nodules (NFTNs) in the United States is surgery, while for autonomously functioning thyroid nodules (AFTNs), radioactive iodine or surgery is preferred, although thionamides may also be used.[6]
The overall risk of complications from thyroid surgery is estimated to be 2% to 20%, with total thyroidectomies associated with more complications than hemi-thyroidectomies.[7] In most cases, surgery is performed under general anesthesia with associated risks, and it results in scar formation.[8,9] Both surgery and radioactive iodine ablation carry the risk of permanent hypothyroidism, resulting in lifelong thyroid hormone replacement.[10–13] To avoid these risks, minimally invasive thermal ablation techniques, including radiofrequency ablation (RFA), laser ablation, microwave ablation, and high-intensity-focused ultrasound are increasingly being used worldwide.[14]
Although all thermal ablation techniques are relatively safe and effective, RFA has shown the most promise in treatment of benign TNs with long-term efficacy reported over 3 to 5 years.[15–19] Studies from South Korea and Italy have shown mean volume reduction of 50% to 93.4% in 6 to 12 months, with significant improvement in symptoms and cosmesis.[20–27] The data regarding the efficacy and safety of RFA from the United States are limited to a retrospective review of 14 patients from Mayo Clinic, Rochester, Minnesota, who were treated under general anesthesia and had a median volume reduction of 44.6% over a median follow-up period of 8.6 months; and a brief report of 24 nodules in 15 patients (excluding 1 patient with recurrent thyroid cancer) from Columbia University, New York, who were treated under local anesthesia and had a mean volume reduction of 52.9% over a mean follow-up period of 1.1 months.[28,29]
Therefore, we report our experience regarding the efficacy and safety of RFA of thyroid nodules performed in an outpatient setting, without general anesthesia, in the United States. We also compare outcomes, including complication rates, with those from already published studies to see if this technique is an acceptable alternative to surgery or other therapies in this population.