Is Radiofrequency RFA a Safe Alternative to Surgery for Benign Thyroid Nodules?
The answer is yes. However, it depends on the skill of the operator. RF ablation has been shown to be an effective treatment modality for benign thyroid nodules.
Major complication was defined as one that, if left untreated, might threaten the patient’s life, lead to substantial morbidity or disability, or result in a lengthened hospital stay. Recent study of 1500 patients found 20/48 complications were major. None of all complications were life threatening. 46/48 recovered without sequelae. 1/48 had permanent hypothyroidism. 1/48 had nodule rupture and had a lobectomy surgery. As in all procedures less experienced operators had higher major complication rates 0.7% vs 2.9%. but total complication rates were not significantly different 2.0% vs 3.9% p=0.51
Twenty (1.4%) major complications were reported.15/20 voice changes , 3/20 nodule ruptures with one with abscess formation, 1/20 hypothyroidism, and 1/20 brachial plexus injury. All 15 had nodules close to the recurrent nerve in the tracheal esophageal groove. This is called the danger triangle. 13/15 recovered their voice completely and 2/15 were lost to follow up. Most recovered their voice by 1-3 months. 1/15 lost the voice due to a bleed not the heated probe.This was acute and waas located between the nodule and the trachea. The probe was removed and compressed her neck for 30 minutes. Her voice recovered completely by 1 hour.
Images before and after the acute hemorrhage causing temporary voice changes.
Image of a nodule too close to the danger triangle.
Three nodule ruptures were detected, at 22, 30, and 50 days after RF ablation. Prior to nodule rupture, the ablated thyroid mass had been decreasing gradually; however, these three patients complained of sudden neck bulging and pain at the time of nodule rupture. 1/3 recovered without treatment.1/3 had a abscess. and had surgery. 1/3 had antibiotics and pain medication only.
Images before and after the rupture on CT. Nodule is smaller but there are new masses seen by arrows.
1/20 major complication was the induction of hypothyroidism in a patient with positive thyroid antibodies before the RFA procedure and elevated TSH 5 months after.
1/20 had brachial plexus injury just after the procedure. Numbness and decreased sensation in 4,5 fingers of left hand. This gradually recovered over 2 months.
Reference for this summary.
Complications Encountered in the Treatment of Benign Thyroid Nodules with US-guided Radiofrequency Ablation: A Multicenter Study