Radiofrequency ablation for management of thyroid nodules: a case report

Abstract

Background: Thyroid nodules constitute a frequently seen clinical problem and the incidence of thyroid nodules has increased with the recently increased use of thyroid ultrasonography. Radiofrequency ablation (RFA) is an effective and safe method for treating benign thyroid nodules and recurrent thyroid cancers.Case Presentation: A 48 years old woman came to the surgical oncology clinic with the presence of a getting bigger, moves when the patient swallows, and painless mass on her neck since 20 years ago. The physical examination measured 5x5 cm mass, mobile on swallowing, no pain on palpation, and the laboratory examination shows a euthyroid state.  The ultrasound result has revealed an enlargement of the right and left thyroid with increased echo intensity of parenchyma and increased vascularisation. This mass was concluded as struma nodus bilateral. The FNAB was follicular neoplasm, Bethesda system class 4. The patient underwent a single session RFA. RFA was performed employing transisthmic access using a 7 cm 18 gauge electrode-needle with a 1 cm active needle tip. The patient well tolerated the procedure and no adverse events were noted. Conclusion: Radiofrequency ablation for thyroid lesions is a safe and effective method for treating benign thyroid nodules and even recurrent thyroid cancers. Therefore, various factors, including serum TSH, clinical risk factor assessment, size of the nodule, ultrasound characteristics, patient preferences, and results of the FNA biopsy, should be considered to manage thyroid nodule.

Radiofrequency ablation for benign thyroid nodule treatment: New solution in our center

“…The conventional open thyroidectomy procedure takes an average of 120 minutes [16] , whereas the RFA procedure in our current report takes an average of 50 min. Our recent report, with RFA procedure takes an average 30 min with average smaller nodule size and with EA procedure also takes an average 30 min with cystic nodule [17] , [18] . MWA procedure takes average 30 min each nodule and average ablation time was 6.97 ± 5.13 min [19] .…”

“…Pain was the most frequent side effect of LA and was recorded as mild or moderate, respectively, in 10.6 % and 1.6 % of patients [23] . The complications that can occur due to ethanol ablation such as localized pain and hematoma in the puncture site, facial flushing, drunken sense, hoarseness, dyspnea, temporary hyperthyroidism, and fibrosis [17] . Morelli et al reported MWA has several minor complications such as heat sensation in the neck, slight pain, first-degree burns, and hematoma without active bleeding in the ablated site.…”

“…In addition, it has been recommended in several guidelines [26] . In the management of thyroid nodules, various factors must be considered including serum TSH, assessment of clinical risk factors, nodule size, ultrasound characteristics, biopsy results, and patient preferences [17] .…”

Radiofrequency ablation for management of thyroid nodules in quarantine zone of COVID-19 pandemic setting in Indonesia

“…Patients can also be immediately discharged after 1 hour of observation. The procedure is also very short, lasting about 30 minutes for a single nodule less than 4 cm although bigger and multiple nodules might require longer procedures [ 17 ]. The PRA procedure also requires a smaller number in the operating team, namely an operator, an assistant, and a circulator.…”

“…In our center, most patients with thyroid lumps present with very large tumors. The largest tumor was 170 cc while the smallest was 5.7c c with the average 85 cc [ 17 ]. The patients will come to the doctor if there are symptoms such as difficulty swallowing, pain, uncomfortable feeling, etc.…”