Thyroid Radiofrequency Ablation of Thyroid Nodules: A 2017 Preview Entry into the United States. Thyroid Nodule Background

Thyroid Radiofrequency Ablation of Thyroid Nodules: A 2017 Preview Entry into the United States. Thyroid Nodule Background

Thyroid Radiofrequency Ablation of Thyroid Nodules: A 2017 Preview Entry into the United States.    Thyroid Nodule Background

Thyroid Radiofrequency Ablation of Thyroid Nodules: A 2017 Preview Entry into the United States.

 

Thyroid Nodule Background

Clinically palpable nodules are found in 5–10% of the normal population and non-palpable nodules occur in up to 67% [1–3].

J. B. Vander, E. A. Gaston, and T. R. Dawber, “The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy,” Annals of Internal Medicine, vol. 69, no. 3, pp. 537–540, 1968

W. M. G. Tunbridge, D. C. Evered, and R. Hall, “The spectrum of thyroid disease in a community: the Whickham survey,” Clinical Endocrinology, vol. 7, no. 6, pp. 481–493, 1977.

G. H. Tan and H. Gharib, “Thyroid incidentalomas: management approaches to nonpalpable nodules discovered incidentally on thyroid imaging,” Annals of Internal Medicine, vol. 126, no. 3, pp. 226–231, 1997

With thyroid imaging I expect that more and more asymptomatic thyroid nodules would be detected.

B.Burguera and H. Gharib, “Thyroid incidentalomas: prevalence, diagnosis, significance, and management,” Endocrinology and Metabolism Clinics of North America, vol. 29, no. 1, pp. 187–203, 2000.

The majority of these nodules are benign and may not cause symptoms, some are occasionally associated with pressure symptoms and cosmetic problems.

E. J. Ha, J. H. Baek, J. H. Lee et al., “Radiofrequency ablation of benign nodules does not affect thyroid function in patients with previous lobectomy,” Thyroid, vol. 23, no. 3, pp. 289–293, 2013.

J. H. Baek, J. H. Lee, R. Valcavi, C. M. Pacella, H. Rhim, and D. G. Na, “Thermal ablation for benign thyroid nodules: radiofrequency and laser,” Korean Journal of Radiology, vol. 12, no. 5, pp. 525–540, 2011.

Surgery was the only treatment for these nodules in the past. However they may be associated with morbidity, neck scar and permanent hypothyroidism.

thyroid-surgery-complications-8-300x134

H. Gharib, “Changing trends in thyroid practice: understanding nodular thyroid disease,” Endocrine Practice, vol. 10, no. 1, pp. 31–39, 2004.

E. L. Mazzaferri, “Management of a solitary thyroid nodule,” The New England Journal of Medicine, vol. 328, no. 8, pp. 553–559, 1993.

D. Linos, K. P. Economopoulos, A. Kiriakopoulos, E. Linos, and A. Petralias, “Scar perceptions after thyroid and parathyroid surgery: comparison of minimal and conventional approaches,” Surgery, vol. 153, no. 3, pp. 400–407, 2013.

B. H.-H. Lang and C.-Y. Lo, “Total thyroidectomy for multinodular goiter in the elderly,” American Journal of Surgery, vol. 190, no. 3, pp. 418–423, 2005

Non-Surgical alternatives include percutaneous ethanol ablation PEI.

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J. Y. Sung, Y. S. Kim, H. Choi, J. H. Lee, and J. H. Baek, “Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation?” American Journal of Roentgenology, vol. 196, no. 2, pp. W210–W214, 2011.

F. Monzani, F. Lippi, O. Goletti et al., “Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts,” Journal of Clinical Endocrinology & Metabolism, vol. 78, no. 3, pp. 800–802, 1994.

M. Zingrillo, M. Torlontano, M. R. Ghiggi et al., “Percutaneous ethanol injection of large thyroid cystic nodules,” Thyroid, vol. 6, no. 5, pp. 403–408, 1996.

Non-surgical methods include Thyroid Radiofrequency Ablation (RFA).

E. J. Ha, J. H. Baek, J. H. Lee et al., “Radiofrequency ablation of benign nodules does not affect thyroid function in patients with previous lobectomy,” Thyroid, vol. 23, no. 3, pp. 289–293, 2013.

J. Y. Sung, Y. S. Kim, H. Choi, J. H. Lee, and J. H. Baek, “Optimum first-line treatment technique for benign cystic thyroid nodules: ethanol ablation or radiofrequency ablation?” American Journal of Roentgenology, vol. 196, no. 2, pp. W210–W214, 2011.

S. Spiezia, R. Garberoglio, C. Di Somma et al., “Efficacy and safety of radiofrequency thermal ablation in the treatment of thyroid nodules with pressure symptoms in elderly patients,” Journal of the American Geriatrics Society, vol. 55, no. 9, pp. 1478–1479, 2007.

W. K. Jeong, J. H. Baek, H. Rhim et al., “Radiofrequency ablation of benign thyroid nodules: safety and imaging follow-up in 236 patients,” European Radiology, vol. 18, no. 6, pp. 1244–1250, 2008.
J. H. Baek, W.-J. Moon, Y. S. Kim, J. H. Lee, and D. Lee, “Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules,” World Journal of Surgery, vol. 33, no. 9, pp. 1971–1977, 2009.
J. H. Baek, Y. S. Kim, D. Lee, J. Y. Huh, and J. H. Lee, “Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition,” American Journal of Roentgenology, vol. 194, no. 4, pp. 1137–1142, 2010.
J. H. Baek, J. H. Lee, J. Y. Sung et al., “Complications encountered in the treatment of benign thyroid nodules with us-guided radiofrequency ablation: a multicenter study,” Radiology, vol. 262, no. 1, pp. 335–342, 2012.
S. W. Jang, J. H. Baek, J. K. Kim et al., “How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation,” European Journal of Radiology, vol. 81, no. 5, pp. 905–910, 2012.
H. K. Lim, J. H. Lee, E. J. Ha, J. Y. Sung, J. K. Kim, and J. H. Baek, “Radiofrequency ablation of benign non-functioning thyroid nodules: 4-year follow-up results for 111 patients,” European Radiology, vol. 23, no. 4, pp. 1044–1049, 2013
J. Y. Sung, J. H. Baek, K. S. Kim et al., “Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized Study,” Radiology, vol. 269, no. 1, pp. 293–300, 2013.
M. Deandrea, P. Limone, E. Basso et al., “US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules,” Ultrasound in Medicine and Biology, vol. 34, no. 5, pp. 784–791, 2008.
S. Spiezia, R. Garberoglio, F. Milone et al., “Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation,” Thyroid, vol. 19, no. 3, pp. 219–225, 2009.
A. Faggiano, V. Ramundo, A. P. Assantiand et al., “Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study,” The Journal of Clinical Endocrinology & Metabolism, vol. 97, no. 12, pp. 4439–4445, 2012. r

Thyroid RFA is a safe percutaneous ablative technique in treating thyroid nodules.The first reported series in 2006.

Y.-S. Kim, H. Rhim, K. Tae, D. W. Park, and S. T. Kim, “Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience,” Thyroid, vol. 16, no. 4, pp. 361–367, 2006.

How does thyroid RFA work in place of thyroid surgery? What are the basic principles?How do we select the patients patients. What is the actual procedure.How effective is the treatment?What are the  known complications of thyroid RFA?

 

Richard Guttler MD,FACE,ECNU

Clinical Professor of Medicine Keck/USC school of Medicine

Director, Santa Monica Thyroid Center, Santa Monica Ca 90404

Member, American Association of Clinical Endocrinologist’s task force on the introduction of thyroid radiofrequency ablation RFA of thyroid nodules to the United States.

dr.guttler@thyroid.com

www.thyroid.com

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