The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules

Abstract

Diving thyroid nodules are a limitation of radiofrequency ablation because the mediastinal component cannot be adequately identified by ultrasound (US). We aim to describe a new technique, the iceberg technique, to overcome this issue and explain our three-year experience of using this novel method. The iceberg technique consists of a two-stage treatment. First, the ablation of the cervical portion of the nodules (easily visualized during the initial US exam) using trans-isthmic access is performed using the moving-shot technique. After three to six months, there is a volumetric reduction of the treated portion, leading to retraction of the thyroid parenchyma. This brings the mediastinal component to the cervical region, thereby enabling a perfect visualization by US. Then, the second stage of treatment is carried out with complete nodule ablation, and the region that was treated first is looked at a second time. From April 2018 to April 2021, nine patients with nine benign nodules were submitted for the iceberg technique. No complications occurred during the entire follow-up period. The patients displayed normal hormonal levels after the procedures, and there was a significant volume reduction of the nodules until three months post-ablation. The iceberg technique is an effective and safe option for the radiofrequency treatment of diving goiters.

Analysis of trends in radiofrequency ablation in a tertiary care center practice

“…Recently, there has been discussion around treating these pre-symptomatic smaller nodules if they have demonstrated continued growth over time. 11,12 The rationale for this decision stems from the greater likelihood of a single and complete ablative procedure that will, in theory, prevent further growth and the development of compressive complaints. However, while this is theoretically appealing, it must be balanced with the risk of an invasive procedure and the relative benefit of intervening on an asymptomatic lesion.…”