Clinical Value of Thyroid RFA

Clinical Value of Thyroid RFA

Clinical Value of Thyroid RFA

Clinical Value of Thyroid RFA

RFA therapy has mainly been aimed at decreasing pressure symptoms, improving the cosmetic results as well as resolving thyrotoxic status in hot nodules.  The thyroid RFA decreased the volume of the nodules.

J. Y. Huh, J. H. Baek, H. Choi, J. K. Kim, and J. H. Lee, “Symptomatic benign thyroid nodules: efficacy of additional radiofrequency ablation treatment session—prospective randomized study,” Radiology, vol. 263, no. 3, pp. 909–916, 2012

Thyroid RFA has mainly been evaluated in terms of reduction of nodule volume, pressure symptoms, and cosmetic symptoms. Volume reductions at 1- and 6-month were 33~53% and 51~92%, respectively.

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

Most patients have reported improvement in pressure and cosmetic symptoms. RFA was far superior to conservative treatment.

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.

After 12 months, patients in the RFA group had significantly decreased mean nodule size  while, the control group had no change. The symptom score improved in the RFA group and there was worsening in the control. Furthermore, the effect of RFA appeared to be last for 2-year follow-up.. Compressive symptoms improved in all patients and were completely resolved in 88% patients.

High nodule volume reduction after a mean follow up of 49 months was seen in one study. Regrowth of more than 50% was very uncommon.

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.

For cystic nodules with <10% solid component, RFA could achieve >90% reduction at 6-month after ablation. However, relative to PEI, RFA was not superior and required more sessions and was more expensive [11, 21].

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.

PEI is not inferior  to RFA. PEI may be the first-line treatment modality for cystic thyroid nodules, which has comparable therapeutic efficacy to, but is less expensive than, RF ablation. Therefore, PEI would still be the first-line ablative measure for cystic nodule. On the other hand, predominant cystic nodule (10–50% solid component) might be suitable for RFA as 6.1–21% failure rates in PEI .

S. Del Prete, G. Facchini, R. Rossiello et al., “Percutaneous ethanol injection efficacy in the treatment of large symptomatic thyroid cystic nodules: ten-year follow-up of a large series,” Thyroid, vol. 12, no. 9, pp. 815–821, 2002.

RFA is generally good in treating the solid component of these refractory nodules.

J. H. Lee, Y. S. Kim, D. Lee, H. Choi, H. Yoo, and J. H. Baek, “Radiofrequency ablation (RFA) of benign thyroid nodules in patients with incompletely resolved clinical problems after ethanol ablation.” World Journal of Surgery, vol. 34, no. 7, pp. 1488–1493, 2010.

Solid nodule (i.e., >50% solid component), RFA could achieve a 23 to 37% volume reduction at the 1st month and 51 to 77% reduction at the 6th month. The rate of volume reduction appears to be maximum after 1–3 months and tends to wean off after 6 months. Besides presence of high cystic content, low vascularity of nodule  and nontoxic status are good predictors for volume reduction.

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.

RFA for hyperfunctioning thyroid nodules, RFA not only reduces the volume but also improves the functional status. The majority has improved thyroid function and reduced the need for antithyroid medication.

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.

Antithyroid medication could be stopped in many patients.  Relative to cold nodules, ablation of hyperfunctioning thyroid nodules achieves lower volume reduction (60% versus 76% at 12 month) and requires more number of sessions (2.2 versus 1.4). In addition, it is important to be more cautious during ablation because incomplete ablation leading to nodule regrowth and hyperthyroid relapse appeared more common in ablation of hot nodules. Therefore, more sessions of RFA are generally needed.

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.



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.

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