A Summary of a Review Article Published by Kai-PunWong and Brian Hung-Hin Lang

 

Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong

 

Thyroid nodules are fluid-filled or solid lumps that form within the thyroid. Most thyroid nodules are benign; however, if they grow big enough to cause symptoms by neck pressing, patients are left with two choices:

  • Remove part of the thyroid through surgery, which requires incisions, general anesthesia, and likely taking thyroid hormone supplements as long as they live.
  • Suffer from all symptoms.

Nodule resection or thyroid lobectomy is the standard treatment. But, many patients develop another nodule with cosmetics and symptomatic problems and also need reoperation. Moreover, thyroid hormone supplements have adverse effects on the cardiovascular system and bones. 

 

The most effective alternative to surgery is radiofrequency ablation or RFA. Radiofrequency ablation is a technique to shrink nodules through heat from the inside. The treatment requires no scarring, surgery, or lifelong hormone therapy. 

 

Procedure Of RFA In Benign Thyroid Nodules

RFA in benign thyroid nodules is done using ultrasound guidance to insert a small needle-like electrode into the thyroid nodule. The needle tip heats up since it’s connected with the generator and destroys the target tissue, causing it to shrink. The RFA therapy has been proven effective and safe treatment for benign thyroid nodules. The treatment is performed as an outpatient process and typically requires a local anesthetic. The process takes around one hour, depending on the nodule size. Patients leave with a small bandage and experience minor bruising and discomfort, which can be treated with pain medications. 

Which patients Can Get RFA Therapy For Thyroid Nodules

Generally, patients with benign nodules considering surgery can select RFA treatment instead. This includes patients with cosmetic issues or symptoms caused by a growing nodule, ones who’ve got a toxic nodule (a nodule that makes excessive thyroid hormone), and patients who can’t safely have surgery like the ones who can’t go under anesthesia. 

Furthermore, RFA should not be implemented in patients who have heart problems or are pregnant. Since several patients had cardiac complications during RFA treatments for liver tumors, it’s advisable to perform continuous cardiac monitoring of patients with severe heart diseases during and after radiofrequency ablation in thyroid nodules. 

Two Techniques To Perform RFA In Thyroid Nodules

  • Fixed Technique

A multi-tined expandable electrode, which is a four-hook expandable needle, is used in the fixed technique. First, the electrode is inserted using ultrasound guidance, then the hook opens, and it is recommended to place it away from the thyroid capsule to avoid injury to critical structures. After that, a local anesthetic is inserted. Finally, the hooks are retracted after the ablation, and the electrode is smoothly withdrawn. 

  • Moving Shot Technique

Since thyroid nodules are ellipsoidal and are complicated to be treated with the fixed technique, the moving shot technique has significantly benefited the RFA. The nodule is divided into several smaller units to be ablated separately when implementing the moving shot technique. In addition, the technique involves using internally-cooled smaller and shorter electrodes, which allows better control of ablation options in treating vital and small structures close to thyroid nodules. 

Using ultrasound guidance, the electrode is inserted so the whole course can be seen and the risk of injury is significantly reduced. The procedure starts with the more peripheral and deeper areas’ treatment because temporary hyperechoic air bubbles appear due to heat, which minimizes the acoustic window for ultrasound monitoring. The treatment ends with a complete nodule that appears entirely replaced by temporary hyperechoic areas. 

 

RFA’s Short And Long-Term Clinical Efficacy

An experiment was conducted on 20 patients to determine the efficacy of RFA treatment compared to other ablative options like laser ablation and ethanol ablation. RFA therapy aims to decrease pressure symptoms and improve cosmetic results and resolve hot nodules’ thyrotoxic status. So, 20 patients were followed up a 1,3, 6, and 12 months after RFA and reported around 53% to 92% nodule volume reductions. Additionally, cosmetic and pressure symptoms were also significantly improved, and the RFA effect appeared to be durable. Compressive symptoms were also improved in all patients. No life-threatening residuals or complications occurred after RFA. 

Furthermore, in patients with a benign hyperfunctioning thyroid nodule, radiofrequency ablation significantly reduced the volume, enhanced the thyroid function, and reduced the need for anti-thyroid medication. 

 

Complications During RFA

Several complications of RFA include voice changes, pain, hematoma, skin burn, thyroid function disturbance, and nodule rupture. The most common complication is pain that radiates to the shoulder, chest, jaw, and ear. Voice change is the most uncommon but severe complication which can be resolved within three months. Hematoma after RFA can be managed easily with neck compressions for several minutes. Besides that, thyroid function disturbances and nodule rupture are late complications of RFA caused by thyroid capsule breakdown and can be treated with antibiotics. Furthermore, transient thyrotoxicosis is another complication that mainly occurs immediately after the RFA but can be recovered within one month. Although no major complication has been examined, following the consensus guidelines and preventative measures are essential.

 

Conclusion

The main weaknesses of RFA treatment include the possibility of incomplete ablation, lack of conclusive histology, and surveillance issues for the residual thyroid mass. However, RFA is an effective non-surgical option to improve toxic and pressure symptoms in benign thyroid nodules. 

 

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Review Article Published by Kai-PunWong and Brian Hung-Hin Lang published on November 3, 2013

Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong

Citation:

Kai-Pun Wong, Brian Hung-Hin Lang, “Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates“, International Journal of Endocrinology, vol. 2013, Article ID 428363, 7 pages, 2013. https://doi.org/10.1155/2013/428363

Disclaimer: None of the information posted is intended as medical, legal, or business advice, or advice about reimbursement for health care services. 

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