BACKGROUND
Thyroid nodules are common and most are benign. However, sometimes patients are bothered by the size of the nodule, either because of symptoms or how it looks and some of these nodules can cause hyperthyroidism. Traditional treatment is generally limited to surgery or radioactive iodine. The problems with surgery include the resultant scar, damage to the nerves in the neck or to the parathyroid glands, the frequent need for thyroid hormone replacement and the requirement to undergo general anesthesia in most cases, which can be limiting in the setting of multiple other medical problems.

More recently, radiofrequency ablation (RFA) has been shown to be safe and effective in treating single benign thyroid nodules. RFA uses heat energy to irreversibly destroy thyroid cells and shrink the target tissue. A probe is inserted into the nodule, much like a thyroid biopsy, and the thermal energy is applied. This study was done evaluate the effectiveness and safety of RFA for benign nodules.

THE FULL ARTICLE TITLE
Kandil E et al 2022 Efficacy and safety of radiofrequency ablation of thyroid nodules: A multi-institutional prospective cohort study. Ann Surg. Epub 2022 Jul 15. PMID: 35837903.

SUMMARY OF THE STUDY
This was a study of patients with thyroid nodules from two major medical centers, previously determined to be benign by thyroid biopsy. They studied 233 patients treated with RFA from July 2019 -January 2022. Monitoring was then performed at 1, 3, 6, and 12 months and then yearly. Items followed were the decrease in volume (considered successful if >50%), size measurements, thyroid state, ultrasound characteristics and procedure complications.

There were 233 nodules studied in the 233 subjects, 76% were female with an average age of 61. Only 4 patients had overactive nodules prior to RFA. Of the initial 233 patients, follow up was available in 162, 71, 85 and 70 patients at 1, 3, 6 and 12 months, respectively. Nodule volume decreased by 54%, 58%, 73% and 76% respectively. By the 12 month follow up exam, the average nodule volume was 0.39 ml compared to 4.17 ml initially. The 4 patients who were hyperthyroid prior to RFA all had normal thyroid function at 3 month follow up.

There were a small number of complications (2.5%) including temporary voice changes, drainage from the RFA site and minor skin burns. One patient developed thyroid overactivity that resolved on its own. Another patient with known Hashimoto’s thyroiditis was started on thyroid hormone replacement. There are some changes in ultrasound after RFA which will require long-term follow up.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that RFA is a useful and safe treatment for benign thyroid nodules that are symptomatic. It is able to significantly decrease the size of a thyroid nodule with minimal complications. While only a small number of patients had hyperfunctioning nodules, RFA also decreased their thyroid levels to normal. This offers another treatment option for patients with symptomatic nodules with a low risk of complications.

— Marjorie Safran, MD

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