Microwave ablation ‘safe and effective technique’ at treating large benign thyroid nodules
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A cohort of adults who underwent microwave ablation to treat solid or mostly solid benign thyroid nodules had a mean shrinkage of more than 60% 6 months after the procedure, according to findings published in Clinical Endocrinology.
“The outstanding advantages of image-guided minimal invasive therapy compared with conventional open thyroidectomy are low recurrent laryngeal nerve injury, good cosmetic result and comfortable ablation in an outpatient setting without general anesthesia,” Mehmet Sercan Erturk, MD, of the division of endocrinology and metabolism, department of internal medicine, at the University of Health Sciences Antalya Training and Research Hospital in Turkey, and colleagues wrote. “Due to these advantages, minimally invasive thermal ablation techniques, such as laser ablation, radiofrequency ablation, and recently, microwave ablation, is rapidly gaining acceptance as treatment options for patients with symptomatic nonfunctioning thyroid nodules.”
Erturk and colleagues conducted a study examining the effects of microwave ablation therapy on thyroid nodules for 46 adults (56.5% women; mean age, 47.5 years) from June 2018 to November 2019. All the participants underwent ultrasound-guided microwave ablation at the University of Health Sciences Antalya Training and Research Hospital’s radiology unit. All participants were euthyroid symptomatic, with solid or predominantly solid benign nodules, and were either ineligible or unwilling to have surgery.
Researchers measured free triiodothyronine, free thyroxine, thyroid-stimulating hormone, thyroglobulin, thyroid peroxidase antibodies and thyroglobulin antibodies on the day of the procedure as well as 24 hours, 3 months and 6 months afterward. Nodules were classified as solid if they were made of 10% or less fluid and predominantly solid if they were composed of 11% to 50% fluid. Therapy was considered a success if there was a 50% or greater volume reduction 6 months after the procedure.
Fourteen participants had solid thyroid nodules while the remaining 32 had nodules classified as predominantly solid. The mean volume reduction for the study cohort was 37.84% at 1 month, 63.09% at 3 months and 68.28% at 6 months.
In post hoc analysis, free T4 levels increased from a median level of 10.81 pmol/L at baseline to 12.29 pmol/L 24 hours after treatment. Free T3 increased from a median of 4.62 pmol/L at baseline to 5.64 pmol/L at 24 hours, and TSH levels decreased from 0.72 IU/L at baseline to 0.49 IU/L. At 6 months, thyroglobulin decreased from a median of 44.75 g/L at baseline to 36.5 g/L at follow-up (P < .001 for all). There was no significant change in thyroid peroxidase and thyroglobulin antibodies at 3- or 6-month follow-up, and no participant developed thyroid antibodies.
Most of the participants reported a tingling or pain sensation in the neck that was tolerated without interrupting the procedure. Six participants had transient voice change lasting 4 to 6 hours. Vocal cord examinations were normal in all participants.
“Considering these results, microwave ablation of benign large solid thyroid nodules under percutaneous is a safe and effective technique for the selected patients because of some advantages, such as low complication rates, good cosmetic results, nodule shrinking rate, etc,” the researchers wrote. “Further studies are necessary to show the effects of microwave ablation on the thyroid function tests.”
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