No Thyroid Surgery: Another Thyroid Disease Has a New First Line of Therapy in Place of Surgery
This well done study comparing RFA to surgery for thyroid nodules confirms prior studies that RFA is a safe alternative for solid benign thyroid nodules. While the majority of nodules can be treated with RFA there still will be some that need surgery. However, the more patients we can treat without surgery the better if the alternative is safe effective and less expensive and improves quality of life of the patient.
Surgery vs Radiofrequency Ablation RFA for Thyroid Nodules: Che et al AJNR 2015 JUL 36( 7)
200 patients with benign solid thyroid nodules had surgery and 200 were treated with RFA. RFA decreased the nodule size from 5 ml to 0.4 ml. Surgery removed the nodule in a lobectomy removal. Both were successful in treating the nodules but it came at the expense of six times the number of surgery related complications. A major complication of surgery was high rate of hypothyroidism. 140 of 200 patients developed life time need for thyroid hormone replacement. The RFA group of 200 had no cases of post RFA hypothyroidism. The other major advantage of RFA is no hospital stay, whereas in this study the average stay after surgery was 6 days. This number may be related to post op complications such as hypocalcemia.
Finally the costs of treatment was the same for RFA and for surgery.However, the RFA was done in the hospital in this study, and usually it is done as an out patient in practice. The Palmer Institute’s Dr.Roberto Valcavi in Italy does RFA for nodules in an out patient setting and the patient leaves after RFA and returns the next day for post RFA ultrasound before leaving to return home.
Surgery is not the first line treatment anymore.
- RFA before and after treatment for thyroid nodules The Thyroid Ablation Probe with short and small bore probe. Roberto Valcavi at Palmer Institute using shortsmall bore probe to do an RFA treatment.One day post RFA contrast Ultrasound shows the area of ablation.
Comments: In the USA we still do not have a thyroid ablation probe system to treat thyroid nodules.The Companies making systems have been slow to grasp the need for a probe that can be used safely in the neck. The larger length and bore thickness of available systems have bleeding problems in the confined space of the neck with so many vital structures within inches of the nodule. RFA, and other systems such as HIFU and MWA will be the way we treat benign thyroid dules in the 21 st century. One more thyroid disease that can be treated without surgery. For now we are sending our patients to Italy or Korea to be treated by RFA. If you are interested call Matt in my thyroid center for details. 1-310-393-8860.
Richard Guttler MD,FACE,ECNU