Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Abstract

Background: Radiofrequency ablation (RFA) is widely accepted as a treatment for non-functioning benign thyroid nodules, mainly to reduce compressive symptoms. In addition to potential compressive symptoms, autonomously functioning thyroid nodules (AFTNs) can cause palpitations, weight loss, diarrhea, increased appetite, flushing, irritability, tiredness, poor sleep, and long-term cardiovascular and musculoskeletal consequences. Currently, there are no United States based RFA practice guidelines for the treatment of AFTNs. However, several reports from Asia and Europe have described the resolution of hyperthyroidism secondary to AFTNs with RFA.Case Description: Three patients with toxic thyroid nodules presented with symptomatic hyperthyroidism, suppressed thyroid-stimulating hormone (TSH), and increased uptake on nuclear medicine thyroid scan. These patients were treated with RFA. At 3 months following ablation, TSH normalized to 2.09, 1.91, and 1.34 mIU/mL respectively. However, temporary hypothyroidism was encountered at 1 month following ablation. All patients discontinued their antithyroid medications following ablation. Nodules exhibited significant volume reductions of 38%, 32%, and 54% from the baseline at 1-month follow-up.Conclusions: RFA potentiates as a safe and effective treatment of toxic thyroid nodules. Though it carries a risk of temporary hypothyroidism following ablation, long-term consequences appear to be minimal.Future study with larger sample size and longer follow-up are encouraged to identify factors predicting response.

Association of BRAFV600E Mutation with the Aggressive Behavior of Papillary Thyroid Microcarcinoma: A Meta-Analysis of 33 Studies

“…Considering the accordingly increased risk of tumor multifocality, ETE, capsular invasion, lymph node metastasis, and disease recurrence in BRAF mutated PTMC, patients with such tumors may be appropriately recommended an intervention of moderate aggressiveness, such as minimally invasive ablative techniques. Radiofrequency ablation (RFA) is one treatment option that has demonstrated impressive safety and efficacy profiles [ 56 , 57 ]. A 2021 study of 102 patients with PTMC found 100% resorption rates at the 5-year follow-up [ 58 ].…”

Bilateral nodule radiofrequency ablation in a single setting: First reported case series

“…RFA has an impressive safety profile in managing a wide range of thyroid disease, including benign, toxic, and malignant nodules 9,10 . In our study, there were no reports of complication.…”

“…RFA has an impressive safety profile in managing a wide range of thyroid disease, including benign, toxic, and malignant nodules. 9,10 In our study, there were no reports of complication. Though our series included only a limited patient population, this is consistent with the current literature which reports a complication rate between 2% and 3%.…”

“…RFA is a minimally-invasive ablative technique used to manage benign, and malignant thyroid nodules. 3,[6][7][8] In our study, we investigated the ablation of bilateral nodules in a single-setting. Importantly, there were no reports of complication in our study.…”

Completion thyroidectomy: A safe option for high‐volume surgeons

“…Considering the aim of this work and its emphasis on safety, it is worth mentioning that minimally invasive ablative techniques are becoming increasingly more common across the United States and may be another safe management option for patients. In specific, radiofrequency ablation (RFA) has been demonstrated to treat benign, 28 toxic, 29 and malignant thyroid nodules 30,31 . A 2017 systematic literature review reported an overall complication rate of 2.38% (95% CI: 1.42%–3.34%), with only a 1.35% rate of major complications 31 .…”