Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation.
BACKGROUND
Percutaneous radiofrequency thermal ablation (RTA) is a promising new therapeutic approach to manage thyroid nodules (TNs). The aim of this study was to investigate the long-term effectiveness of RTA in inducing shrinkage of TNs as well as in controlling compressive symptoms and thyroid hyperfunction in a large series of elderly subjects with solid or mainly solid benign TNs.


METHODS
Ninety-four elderly patients with cytologically benign compressive TNs were prospectively enrolled in the study; 66 of them had nontoxic goiter and 28 had toxic or pretoxic goiter. RTA was performed by using a RITA StarBurst Talon hook-umbrella needle inserted in every single TN under ultrasonographic real-time guidance. TN volume, TN-related compressive symptoms and thyroid function were evaluated at baseline and 12 to 24 months after RTA.


RESULTS
All TNs significantly decreased in size after RTA. The mean decrease in TN volume 12 months after RTA was from 24.5 +/- 2.1 to 7.5 +/- 1.2 mL (p < 0.001), with a mean percent decrease of 78.6 +/- 2.0%. Two years after RTA, a 79.4 +/- 2.5% decrease of TNs size was observed. Compressive symptoms improved in all patients and completely disappeared in 83 of 94 (88%) patients. Hyperthyroidism resolved in most patients allowing methimazole therapy to be completely withdrawn in 79% of patients with pretoxic and toxic TNs (100% with pretoxic TNs and 53% with toxic TNs). The treatment was well tolerated by all patients. No patient needed hospitalization after RTA and no major complications were observed.


CONCLUSIONS
RTA is an effective and simple procedure for obtaining lasting shrinkage of TNs, controlling compressive symptoms, and treating thyroid hyperfunction. When performed in experienced medical centers, RTA may be a valid alternative to conventional treatments for nontoxic and pretoxic TNs. It is particularly attractive for elderly people for whom surgery and radioiodine therapy are often contraindicated or ineffective.
Spiezia
Stefano
S
Department of Surgery, Ultrasound Guided & Neck Pathologies Surgery Operative Unit, S. Maria del Popolo degli Incurabili ASLNA1 Hospital , Naples, Italy.
Garberoglio
Roberto
R
Milone
Francesco
F
Ramundo
Valeria
V
Caiazzo
Corrado
C
Assanti
Angelo Pio
AP
Deandrea
Maurilio
M
Limone
Paolo P
PP
Macchia
Paolo E
PE
Lombardi
Gaetano
G
Colao
Annamaria
A
Faggiano
Antongiulio
A
D000368:Aged; D000369:Aged, 80 and over; D013956:Antithyroid Agents / Q000627:therapeutic use; D005260:Female; D006044:Goiter, Nodular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000188:drug therapy; D008297:Male; D011446:Prospective Studies; D016634:Radiosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D025321:Surgery, Computer-Assisted; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000503:physiopathology; D013963:Thyroid Hormones / Q000097:blood; D016606:Thyroid Nodule / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
D013956:Antithyroid Agents; D013963:Thyroid Hormones