title: Clinical review: Nonsurgical, image-guided, minimally invasive therapy for thyroid nodules.
abstract: BACKGROUND
  Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been our main option for treatment.
  
  
  OBJECTIVE
  In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs.
  
  
  METHODS
  We selected recent publications related to minimally invasive thyroid techniques, with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords.
  
  
  RESULTS
  In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data.
  
  
  CONCLUSIONS
  Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective and can be used to treat symptomatic or enlarging thyroid masses.
authors: Division of Endocrinology, Diabetes, Metabolism, Nutrition, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. gharib.hossein@mayo.edu.
authors: Hossein
authors: H
authors: Gharib
authors: Laszlo
authors: L
authors: Hegedüs
authors: Claudio Maurizio
authors: CM
authors: Pacella
authors: Jung Hwan
authors: JH
authors: Baek
authors: Enrico
authors: E
authors: Papini
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D000431:Ethanol / Q000627:therapeutic use*; D006801:Humans; D008872:Microwaves; D012008:Recurrence; D016606:Thyroid Nodule / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
chemical_list: D000431:Ethanol