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

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

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

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

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

Introduction Comments

Radiofrequency Ablation has been reported in various tumors including liver or kidney tumors but not for thyroid in the USA.  However thyroid RFA has been reported to be a safe and efficient treatment option in managing symptomatic cold thyroid nodules or hyperfunctioning thyroid nodules in other countries. Cosmetic and symptoms have been shown to be significantly improved both in the short and long terms after RFA.

us

Hyperfunctioning thyroid nodules, RFA is indicated when surgery or radioiodine are not indicated or patient refuse surgery or radio-iodine. Thyroid function improves with decreased need for antithyroid medications.

toxic

RFA complication rate is relatively low compared to surgery.

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.

gjdqzomyljaek3wmbszulp1vit6r5z-vh1dx-bkvolxjexh_fr527z0bofkmcutivpa8qs125%c2%a6%d0%b1%c2%a6%d1%8d%c2%a6%d1%88%c2%a6%d1%8c%c2%a6%d1%8a%c2%a6%d1%880242-300x225%c2%a6%d0%b1%c2%a6%d1%8d%c2%a6%d1%88%c2%a6%d1%8c%c2%a6%d1%8a%c2%a6%d1%880244-300x225

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?

How Does Thyroid RFA work?

Thyroid RFA works similar to liver RFA and refers to heat ablation by high frequency alternating electric current oscillating between 200 and 1200 kHz.

 

elec-effectheat

 

H. Rhim, S. N. Goldberg, G. D. Dodd III et al., “Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors,” Radiographics, vol. 21, pp. S17–S35, 2001

 

sratmed_companystar-rf-electrode_1

The thyroid RFA electrode placed into the nodule, produces high-frequency alternating current  passing into the surrounding tissue. The rapid vibration of surrounding ions and frictional heat causes necrosis and irreversible damage near the electrode at temperature between 50°C and 100°C. Temperature higher than 100°C would lead to vaporization and carbonization.

L. Buscarini and S. Rossi, “Technology for radiofrequency thermal ablation of liver tumors,” Surgical Innovation, vol. 4, no. 2, pp. 96–101, 1997.

Beside the frictional heat produced by oscillating ions, conduction of heat causes further damages to the surrounding remote area in a slower manner.

This is the basis of RFA.

S. N. Goldberg, “Radiofrequency tumor ablation: principles and techniques,” European Journal of Ultrasound, vol. 13, no. 2, pp. 129–147, 2001.

In this experimental study, temperature measurements around the RFA electrode in the pig thyroid gland were taken. The maximum temperature at a distance of 5 mm from the RFA electrode was between 44°C and 61°C while, at a distance of 10 mm, a maximum temperature of 53°C was achieved. Even at this low temperature, there were signs of irreversible cell death damage in the region of the thermal lesions.

J.-P. Ritz, K. S. Lehmann, T. Schumann et al., “Effectiveness of various thermal ablation techniques for the treatment of nodular thyroid disease—comparison of laser-induced thermotherapy and bipolar radiofrequency ablation,” Lasers in Medical Science, vol. 26, no. 4, pp. 545–552, 2011

How do we decide which patient is a candidate for thyroid RFA?

In 2012, the Korean Society of Thyroid Radiology made a consensus statement regarding the treatment of thyroid nodules with RFA.

D. G. Na, J. H. Lee, S. L. Jung et al., “Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations,” Korean Journal of Radiology, vol. 13, no. 2, pp. 117–125, 2012.

Thyroid RFA is indicated either for patients with nodule-related symptoms or with hyperfunctioning nodule(s) which is causing thyrotoxicosis.

Confirmed to be benign with at least two separate US-guided fine-needle aspiration cytology and/or core biopsies.

Y. C. Oertel, L. Miyahara-Felipe, M. G. Mendoza, and K. Yu, “Value of repeated fine needle aspirations of the thyroid: an analysis of over ten thousand FNAs,” Thyroid, vol. 17, no. 11, pp. 1061–1066, 2007. View at Publisher · View at Google Scholar · View at Scopus
J. Y. Kwak, H. Koo, J. H. Youk et al., “Value of US correlation of a thyroid nodule with initially benign cytologic results,” Radiology, vol. 254, no. 1, pp. 292–300, 2010

In general, RFA is a safe procedure. However, we should be cautious in application of RFA in patients who are either pregnant or having history of serious heart problems.. Since there had been reports of cardiac complication during RFA for liver tumors, patients with serious heart disease should have continuous cardiac monitoring during and after RFA of thyroid nodules.

A. A. Nemcek Jr., “Complications of radiofrequency ablation of neoplasms,” Seminars in Interventional Radiology, vol. 23, no. 2, pp. 177–187, 2006.

Thyroid RFA procedure

The patient should be positioned in supine with neck slightly extended. Local anesthetic with lignocaine is then injected underneath the skin near the cervical-surrounding soft tissue and thyroid capsule.

kjr-18-615-g002-l

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.

J. H. Baek, Y. S. Kim, J. Y. Sung, H. Choi, and J. H. Lee, “Locoregional control of metastatic well-differentiated thyroid cancer by ultrasound-guided radiofrequency ablation,” American Journal of Roentgenology, vol. 197, no. 2, pp. W331–W336, 2011.
J. H. Baek, H. J. Jeong, Y. S. Kim, M. S. Kwak, and D. Lee, “Radiofrequency ablation for an autonomously functioning thyroid nodule,” Thyroid, vol. 18, no. 6, pp. 675–676, 2008

Some would also administer premedication of fentanyl and midazolam to minimize discomfort.

J. M. Monchik, G. Donatini, J. Iannuccilli, and D. E. Dupuy, “Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma,” Annals of Surgery, vol. 244, no. 2, pp. 296–304, 2006.

Grounding pads are adhered to both thighs and are connected to RF generator, and the generator was connected to RF electrode in unipolar systems only.

images

 

The “moving shot” technique is the method of choice. This technique was first described by Baek et al. in Seoul, Korea.

moving-shot

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.
A straight internally-cooled  short  thin electrode is used. The electrode is usually 15 cm in  (7 cm shaft length) and smaller (18-19 gauge) electrode with active tips around 0.5, 0.7, 1, 1.5, and 2 cm.probes

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

With these shorter and smaller electrode, it allows better control and variation of ablation option in treating small or vital structure closed thyroid nodule. The “moving shot technique”, targets thyroid nodule in divided units and during the procedure, each conceptual unit is being ablated by the moving ablation electrode tip. The electrode is inserted through the isthmus under the US guidance. The whole course of electrode could be seen and that greatly reduces the risk of injury of the nearby structures. The ablation first starts from the deepest layer up and so the electrode is slowly withdrawn to the surface.

It is important that the region close to the trachea-esophageal groove be less treated in order to avoid injury to the recurrent laryngeal nerve, trachea, and esophagus as this area is often referred to as the “danger triangle”.

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.

Complications: What can go wrong?

RFA can cause neck pain, voice changes, skin burn, hematoma, nodule rupture, and alter thyroid function. Most of the patients recover well with proper treatment with very few complications. In a Korean multicenter study involving 1459 patients, there were 3.3% patients with complications and, of these, 1.4% had major complications.

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.

complications

Pain is the most common reported complication during the procedure. It occasionally radiates to ear, shoulder, jaw, and chest. However, it is usually self-limiting and resolved soon when the power of RFA has been decreased or switched off. Simple oral analgesic and only 5.5% of patients require analgesic for more than 2 days.

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.

Voice change after RFA is not common but, nevertheless, it is a serious complication. Thermal injury to recurrent laryngeal nerve or vagas nerve. Recovery within 3 months is usual. this, Under-treating near tracheoesophageal groove is recommended.

img_0653

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

No reports of skins burn by grounding pads. This is probably because of the lower energy used during ablation.

Rhim, S. N. Goldberg, G. D. Dodd III et al., “Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors,” Radiographics, vol. 21, pp. S17–S35, 2001.

Neck first degree burns have been reported. Most patients recover from pain and skin color change within 7 days. Application of ice bag to puncture site might prevent skin burn.

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.

Haematoma after thyroidectomy is a distress complication. It happens after RFA but could be managed conservatively with the compression of neck for several minutes. It is usually caused by injury of perithyroidal or anterior jugular vessels during electrode insertion. Proper assessment of perithyroidal and anterior neck and use of small size needle might prevent mechanical injury during insertion.

B. H. H. Lang, P. C. L. Yih, and C. Y. Lo, “A review of risk factors and timing for postoperative hematoma after thyroidectomy: is outpatient thyroidectomy really safe?” World Journal of Surgery, vol. 36, no. 10, pp. 2497–2502, 2012.

J. H. Shin, J. H. Baek, E. J. Ha, and J. H. Lee, “Radiofrequency ablation of thyroid nodules: basic principles and clinical application,” International Journal of Endocrinology, vol. 2012, Article ID 919650, 7 pages, 2012.

Nodule rupture is a rare late complication one moth after ThyroidRFA. A sudden neck bulging and pain at the time of rupture. It is caused by breakdown of thyroid capsule and internal bleeding. These patients should be managed with antibiotics and closely monitored since abscess formation is a potential sequel requiring subsequent operation.

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.

Transient thyrotoxicosis immediately after ThyroidRFA has been reported. All patients were asymptomatic and spontaneously recovered within 1 month.

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.

Ha et al. reported that RFA did not affect thyroid function even in patients who had undergone lobectomy.

 

images

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.

Although there were no fatal complication or ultramajor complication, tracheal injury, esophageal injury, or permanent voice changes have been reported, it is important to be cautious during the procedure and always trace the electrode tip before starting ablation.

J. H. Kim, H. K. Lee, J. H. Lee, I. M. Ahn, and C. G. Choi, “Efficacy of sonographically guided percutaneous ethanol injection for treatment of thyroid cysts versus solid thyroid nodules,” American Journal of Roentgenology, vol. 180, no. 6, pp. 1723–1726, 2003.

One complication of brachial plexus injury reported in 1459-patient study. Though rare, to minimize these complications, studying preventive measures and following the consensus guidelines are essential

D. G. Na, J. H. Lee, S. L. Jung et al., “Radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: consensus statement and recommendations,” Korean Journal of Radiology, vol. 13, no. 2, pp. 117–125, 2012.

 

Final Words on Thyroid RFA by Dr.Guttler

 

Main weaknesses is in using RFA on the thyroid gland include the lack of definitive histology, possibility of incomplete nodule ablation, and surveillance problems for the residual thyroid mass after RFA.

However, RFA is an an effective nonsurgical option to improve pressure and toxic symptoms in benign thyroid nodules.  Volume reduction, pressure symptoms, and cosmetic symptoms, can be improved and  appear last long term. Therefore, proper selection of patient with benign nodule for RFA and subsequent monitoring were needed.

New developments in Thyroid RFA

tracker

Needletracker system for teaching Thyroid RFA.

kjr-18-615-g001

1/2 hot tip for close danger objects

 

kjr-18-615-g003

Ablation of sinking arterioles before the Thyroid RFA.

rf_draw_tech_bp4

pregnancy-can-trigger-hashis-copy

Bipolar electrode for pregnant and pacemaker patients.

No grounding pads.

Microdissection method (Dextrose avoidance) when the target nodule is too close to a dangerous structure

 

img_1423

Thanks to Dr. JH Baek at Asan MC Seoul Korea for his input and images.

 

and Dr. Kai-Pun Wong and Brian Hung -Lin Lang  of Queen Mary Hospital Hong Kong for their review article

https://www.hindawi.com/journals/ije/2013/428363/

Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860