Aims and objectives
Benign thyroid nodules are very common,
but their treatment is mainly justified if they become symptomatic or cause cosmetic alterations.
Until a few years ago,
surgery was the only treatment available,
but radiofrequency ablation (RFA) and ethanol ablation (EA) guided by ultrasonography appeared as safe and effective alternatives (1,
2).
These techniques increased the number of indications,
including significant growth during follow-up and patients that refuse surgical treatment or with surgical risk (2),
but also it can be used in patients with difficult management of...
Methods and materials
We conducted a retrospective study from 2013 to 2018 which included 99 patients with clinically relevant benign thyroid nodules who met the eligibility criteria and provided written informed consent.
None of our patients were treated with RFA because of difficult management of post-surgical hypothyroidism.
Thyroid nodules were clinically assessed with a symptomatic score using a 10-cm visual analog scale (0-10) and a cosmetic grading score (1,
no palpable mass; 2,
no cosmetic problem but a palpable mass; 3,
a cosmetic problem on swallowing only; and...
Results
Anatomy
The thyroid region includes several anatomic structures such as carotid artery,
internal jugular vein,
esophagus and trachea (Fig. 1),
which are important to recognize in order to avoid complications.
For instance,
the recurrent laryngeal nerve evaluated directly (Fig. 2) or by its function in the vocal cord movement (Fig. 3),
the middle cervical ganglion (Fig. 4),
the anterior thyroid veins (Fig. 5).
These last ones have to be circumvented during the transisthmic approach.
Inthe vast majority of cases,
transisthmic approach and visualization of the...
Conclusion
RFA and EA are safe and effective alternative treatments to surgery in clinically relevant benign thyroid nodules.
The greatest volume reduction is observed after 6-months follow-up.
The only variable in our cohort that predict a better outcome after 6-months follow-up was the greater percentage of cystic portion
Antibodies measured during follow-up didn’t change after RFA.
In patients with hyperfunctionant nodules,
hormonal indicators were stabilized after the treatment.
There are several important anatomic structures in the thyroid region to consider during RFA and EA.
Other lesions...
Personal information
José Miguel Escudero-Fernández
Department of abdominal imaging
Hospital Universitari Materno-Infantil Vall d’Hebron,
Institut català de la Salut.
Passeig de la Vall d’Hebron 119-129 08035 Barcelona Spain
Email:
[email protected]
References
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Benign Predominantly Solid Thyroid nodules: Prospective Study of Efficacy of sonographically Guided Radiofrequency Ablation Versus Control Condition.
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2017 Thyroid Radiofrequency ablation Guideline: Korean Society of thyroid Radiology.
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Sung et al.
Optimum First-Line Treatment Technique for Benign Cystic Thyroid Nodules: Ethanol Ablation or Radiofrequency Ablation?.AJR 2011; 196:W210–W214
Jung et al.
Efficacy and Safety of radiofrequency Ablation for Benign Thyroid nodules: A Prospective Multicenter Study.Korean J Radiol 2018;19(1):167-174
Shin Ahn et al.
Radiofrequency ablation...