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Radiofrequency ablation viable option for symptomatic benign thyroid nodules
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Adults with symptomatic benign thyroid nodules who underwent a single, monopolar radiofrequency ablation treatment in lieu of surgery experienced significant overall nodule volume reduction at 12 months with mostly minor, transient complications, according to findings from a single-center study conducted in Austria.
“A single radiofrequency ablation of benign cold as well as hot thyroid nodules is a safe and highly effective alternative for patients who do not want to have a thyroid surgery performed,” Harald Dobnig, MD, professor of internal medicine and head of the Schilddrüsen Endokrinologie Osteoporose Institut in Graz, Austria, told Endocrine Today. “As it is true for other novel, minimally invasive medical treatments, radiofrequency ablation allows for a patient-tailored approach that provides a way to maintain normal organ function in most cases while reducing or eliminating clinical symptoms.”
In a prospective analysis, Dobnig and Karin Amrein, MD, MSc, associate professor and consultant in internal medicine and endocrinology at the Medical University of Graz, Austria, analyzed data from 277 patients with benign thyroid nodules undergoing radiofrequency ablation between April 2014 and June 2017, with 77.2% presenting with an external report recommending thyroid surgery (mean age, 52 years; 77.6% women). All patients underwent a single radiofrequency ablation session using internally cooled 18G radiofrequency electrodes (STARmed) using a free-hand, “moving-shot” technique following local perithyroidal anesthesia. Researchers assessed efficacy via standard thyroid function tests at 3 and 12 months for 300 and 154 nodules, respectively.
Within the cohort, 74.4% of nodules were solid or predominantly solid (mean volume, 13.6 mL), 12.1% were mixed (mean volume, 14.1 mL) and 13.5% were cystic or predominantly cystic (mean volume, 15.9 mL). Average radiofrequency ablation treatment was 39.8 minutes.
At 3 and 12 months, mean overall nodule volume reduction rates were 68% and 82%, respectively (P < .001). At 12 months, 81% of nodules exhibited a volume reduction rate of at least 70%. Researchers found that nodule shrinkage was accompanied by an improvement in cosmetic and symptom scores.
In 32 patients with subclinical or overt hyperthyroidism, 27 (84.3%) became euthyroid, one developed subclinical hypothyroidism and four patients had subclinical hyperthyroidism at their last follow-up visit. Adverse events included voice change (1.8%), hyperthyroidism (0.7%), wound infection treated with antibiotics (0.3%) and epifascial hematoma (0.3%).
Among euthyroid patients, researchers observed a small but significant rise in serum thyroid-stimulating hormone levels, from a mean of 1.42 mIU/L at baseline to 1.8 mIU/L at 12 months. Changes in mean free thyroxine and triiodothyronine levels did not rise to significance, according to researchers.
The researchers noted that the findings confirm the safety and efficacy of radiofrequency ablation and provide data for future discussions about possible selection criteria for patients with benign thyroid nodules.
“Future studies need to demonstrate the cost-effectiveness of such an approach by especially looking at the long-term recurrence rates of radiofrequency ablation-treated thyroid nodules,” Dobnig said. – by Regina Schaffer
For more information:
Harald Dobnig, MD, can be reached at Schilddrüsen Endokrinologie Osteoporose Institut, Jakob-Redtenbachergasse 10, 8010 Graz, Austria; email: herald.dobnig@hormoninstitut-dobnig.at.
Disclosures: The authors report no relevant financial disclosures.
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