Assessment of thyroid-specific quality of life in patients with benign symptomatic thyroid nodules treated with radiofrequency or ethanol ablation: a prospective multicenter study

Quantification of Initial Symptom Relief Following Ultrasound-Guided Radiofrequency Ablation of Benign Thyroid Nodules

ABSTRACT

The use of radiofrequency ablation (RFA) of benign, symptomatic thyroid nodules is growing in clinical practice. Objective outcomes of symptom relief are needed to support the use of this treatment. Thus, a previously established thyroid nodule symptom scoring system was prospectively administered to patients prior to RFA of symptomatic thyroid nodules and then at 1, 3, 6, and 12 months following ablation.A total of 38 patients of mean age 57 years were treated with RFA between August 2022 and January 2024 and completed at least 1 follow-up survey. Five of these patients underwent simultaneous ablation of 2 thyroid nodules; the remainder had a single nodule treated. Mean modified symptom score prior to RFA was 3.5 (SD 1.6) with higher scores correlating with increasing baseline nodule volume (R = 0.46, P = 0.0038). Patient symptom scores decreased at the first 1-month survey (mean 1.2; SD 1.3) and 3-month survey (mean 0.9; SD 1.3) with durable response in those patients with more extended follow-up. In those patients with imaging follow-up, decreasing nodule size was shown to correlate with decreasing symptoms.The early results of this study show that RFA of benign, symptomatic thyroid nodules results in quantifiable symptom relief within 3 months of treatment. Such objective measures of symptom relief may be used to measure long-term durability of treatment.

Radiofrequency Ablation of Benign Thyroid Nodules: 10-Year Follow-Up Results From a Single Center

OBJECTIVE

The long-term efficacy of radiofrequency ablation (RFA) for the treatment of benign thyroid nodules remains unclear. We aimed to evaluate the long-term efficacy, emphasizing single-session RFA, and identify the factors associated with cases requiring additional RFA sessions to achieve a comparable volume reduction rates (VRR).

MATERIALS AND METHODS

We retrospectively evaluated benign thyroid nodules treated with RFA between 2008 and 2018. Treatment efficacy at the 5- and 10-year follow-ups was analyzed. Additionally, subgroup analysis comparing technique efficacy, such as the final VRR, between the single- and multi-session RFA groups was performed. Continuous variables were analyzed using the two-sample t-test or Mann-Whitney U test, and categorical variables were analyzed using the Chi-square or Fisher's exact test.

RESULTS

A total of 267 nodules from 237 patients (age: 46.3 ± 15.0 years; female: 210/237 [88.6%]) were included. Of these, 60 were analyzed for the 5-year follow-up (mean follow-up duration ± standard deviation: 5.8 ± 0.4 years) and 29 for the 10-year follow-up (10.9 ± 0.9 years). Single-session RFA showed a median VRR of 95.7% (5th year) and 98.8% (10th year), while multi-session RFA showed comparable median VRRs of 97.4% (5th year) and 96.9% (10th year). The vascularity type, demographic factors, nodular components, and locations did not significantly differ between the single-session and multi-session RFA groups. However, nodules with pre-RFA volume <10 mL were more prevalent in the single-session RFA group than in the multi-session RFA group (5th year: 64.3% [18/28] vs. 34.4% [11/32], P = 0.040; 10th year: 75.0% [12/16] vs. 23.1% [3/13], P = 0.016).

CONCLUSION

Single-session RFA may be sufficient for achieving adequate volume reduction during long-term follow-up for small-volume benign thyroid nodules. A high VRR was maintained regardless of the nodular component, location, demographic factors, or vascularity type. However, large-volume nodules may require multiple RFA sessions to achieve a comparable VRR.

Improvement in thyroid-specific quality of life following radiofrequency ablation of benign thyroid nodules: A USA study

BACKGROUND

Radiofrequency ablation is an effective minimally invasive technique for benign thyroid nodules, with European and Asian studies reporting improved quality of life following treatment. We aimed to assess the thyroid-related quality of life of patients with benign thyroid nodules treated with radiofrequency ablation in the United States.

METHODS

This is a prospective single-institution study of patients treated with radiofrequency ablation over a 4-year period. Nodule characteristics and Thyroid-Related Patient-Reported Outcome (ThyPRO)-39 scores were assessed at baseline, 3 months post-procedure, and last follow-up (range: 3-12 months). Wilcoxon signed-rank test was used to assess differences in scores before and after radiofrequency ablation with standardized effect size analysis.

RESULTS

A total of 56 patients with 76 nodules were treated. The median volume reduction ratio at 1, 3, 6, and 12 months was 44.9% (interquartile range: 27.3-57.3), 65.2% (53.5-73.1), 69.7% (63.5-81.9), and 79.6% (66.2-88.9), respectively. At 3-month follow-up, significant improvement (P < .05) was observed for goiter symptoms (28.9 vs 10.8), anxiety (30.7 vs 19.3), and appearance (29.9 vs 10.8). At last follow-up, significant improvement (P < .05) was observed for goiter symptoms (28.9 vs 8.9), anxiety (30.7 vs 22.3), appearance (29.9 vs 10.8), and overall quality of life (30.3 vs 11.1). Effect sizes were moderate for appearance (standardized effect size 0.5-0.8) at last follow-up.

CONCLUSION

In the largest US study to date assessing quality of life following radiofrequency ablation, we observed an expected volume reduction ratio and improvements in thyroid-specific quality of life, particularly in the goiter, anxiety, and appearance domains.

Minimally invasive techniques for the management of benign thyroid nodules: Efficacy and impact on quality of life of percutaneous ethanol injection. Results from a high-resolution thyroid nodule unit

BACKGROUND AND OBJECTIVE

The high incidence of thyroid nodular disease has raised concerns on the therapeutic management of benign thyroid nodules. The development of minimally invasive techniques is an alternative to surgery and has a low rate of complications. Our objective was to evaluate the safety and efficacy profile of percutaneous ethanol injections (PEI) with ethanol aspiration of symptomatic cystic and predominantly cystic thyroid nodules (cystic component > 50%) treated in the thyroid nodule high-resolution unit (TNHRU) of Hospital de Tortosa Verge de la Cinta Hospital, Tarragona, Spain.

PATIENTS AND METHODS

The present work is a prospective, observational and descriptive study of 32 patients (87.5% women, mean age of 43; SD, 12) evaluated at the TNHRU from August 2022 through December 2023. Demographic data such as age, sex, previous thyroid function, diagnostic method, initial nodular volume, nodular composition and nodular location were analyzed. Using ultrasounds, measurements of diameters and thyroid nodule volume were taken. We aspirated a total of 50% of the cystic content and injected between 2 mL and 5 mL of 99% ethanol (depending on cystic volume). After letting the ethanol act inside the nodule for 5 to 10 minutes, all the cystic content and the injected ethanol were aspirated. We performed an ultrasound follow-up at 1, 3 and 6 months, calculating the total volume and the volume reduction rate (VRR). The impact on health-related quality of life (HRQoL) was assessed using the ThyPRO-39es questionnaire, which was administered before and after the PEI treatment at the 6-month follow-up.

RESULTS

The median volume reduction at the end of the 6-month follow-up was 0.23 mL (0.00-0.67), and the VRR, 98.57% (94.80-100.00). The difference between the initial volume and the mean volume at the 1-, 3-, and 6-month follow-ups was statistically significant, as was the VRR between the 1-month and the 3- and 6-month follow-ups. Six patients (18.80%) required 2 PEIs and only 2 patients (6.3%) required 3 PEIs. The overall quality of life, which was scored from 0 (good) to 4 (poor), significantly improved from 1.28; SD, 0.81 up to 0.19; SD, 0.40 (p < 0.001).

CONCLUSIONS

PEI is an effective alternative to treat cystic thyroid nodules resulting in an improved patients' HRQoL. It can be performed outpatiently with a low rate of complications, thus making it suitable for inclusion in the service portfolio of a HRTNU.

Prevalence and Management of Complications of Percutaneous Ethanol Injection for Cystic Thyroid Nodules: A Systematic Review of Literature and Meta-analysis

Background: We assessed the prevalence of complications from percutaneous ethanol injection (PEI) for benign and cystic thyroid nodules (CTNs) and their management. Methods: We conducted a systematic review with meta-analysis of data from published observational studies on PEI of CTNs. We also included unpublished retrospectively collected data on complications after PEI from all consecutive patients with cytologically benign CTNs who underwent PEI at the Unit of Endocrinology and Metabolic Diseases, AOU University of Campania Luigi Vanvitelli (Naples, Italy) between June 1, 2021, and March 31, 2024. A random effects meta-analysis was performed on the prevalence rate data. Pooled prevalence data were presented with confidence intervals (CIs). The I2 statistic index was used to quantify the heterogeneity. The details of the complications and the management were qualitatively described. Results: The literature search yielded 1189 studies, of which 48 studies were included in the systematic review and meta-analysis, in addition to our institutional experience (3670 CTNs in total). The overall quality of each included study was judged as fair. The prevalence of "Overall" complications of PEI was 32% ([CI 25-40%], I2 92.7%, 967 of 3195 thyroid nodules [TNs]). The prevalence of "Minor" complications of PEI was 32% ([CI 25-40%], I2 92.7%, 952 of 3195 TNs). The prevalence of "Major" complications of PEI was 2% ([CI 1-2%], I2 0%, 22 of 3670 TNs). Sensitivity analyses did not modify the results. The pooled prevalence rate of local pain was 21% (CI [16-27] I2 90.3). Local pain was typically transient and mild, sometimes moderate, and requiring analgesics for few days. The pooled prevalence rate of dysphonia was 1% (CI [1-2], I2 0). Dysphonia was transient and could last from several hours to 12 months after PEI. Conclusions: Complications of PEI for benign and CTNs are relatively common, but most are minor and usually transient, not requiring treatment. Dysphonia was a major complication, but it was uncommon and transient. PEI for CTNs could be considered a generally safe technique.

Comparison of the effectiveness of ultrasound-guided radiofrequency ablation and conventional open thyroidectomy in the treatment of benign thyroid nodules

Objective

To compare the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) and conventional open thyroidectomy (OT) in the treatment of benign thyroid nodules (BTN).

Methods

Medical records of 103 patients with BTN undergoing surgical treatment at The Affiliated Jiangning Hospital of Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Records show that 53 patients underwent US-guided RFA (observation group) and 50 patients underwent conventional OT (control group). Perioperative indicators (operation duration, intraoperative blood loss, postoperative hospital stay, incision length, and VAS score 12h and 24h after surgery), complications, thyroid function, and nodule recurrence in both groups were compared and analyzed.

Results

Perioperative indicators of patients in the observation group were better, and the visual analogue scale (VAS) scores at 12 and 24 hours after the surgery were lower than those of the control group (p<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). There was no statistically significant difference in the preoperative levels of thyroid-stimulating hormone (TSH), serum free thyroxine (FT4) and serum free triiodothyronine (FT3) between the two groups (p>0.05). The postoperative TSH levels in the observation group increased compared to the preoperative levels and were higher than those in the control group, while FT4 and FT3 levels decreased after surgery and were lower than those in the control group (p<0.05).

Conclusions

Compared to conventional open thyroidectomy, US-guided RFA is associated with less trauma, faster recovery, fewer complications, and less impact on thyroid function in the treatment of patients with BTN.

A Multi-dimensional Data Mining-based Study on the Prescriptions Developed by Professor Xu Zhiyin in Treating Thyroid Nodules

OBJECTIVES

In this study, we employed a multi-dimensional data mining approach to examine the clinical instances where Professor Xu Zhiyin treated thyroid nodules. Our aim is to understand the patterns of symptoms, underlying causes, and treatment approaches used for thyroid nodules. By doing so, the intention is to distill the essential aspects, compile Professor Xu Zhiyin's clinical insights, and investigate his scholarly perspectives.

METHODS

Professor Xu Zhiyin's clinical diagnoses and treatments spanning from 2009 to 2019 were entered into Microsoft Excel. Subsequently, the collected data was imported into the Medcase V5.2 system to facilitate data mining. Various techniques, such as frequency-based method, association rule analysis, and clustering, including a decentralized system clustering approach, were employed on a set of 346 cases involving patients with thyroid nodules that conformed to the specified criteria. The primary focus was on extracting insights regarding symptoms and the underlying causes from the medical records. By integrating these findings with Professor Xu Zhiyin's clinical expertise, we examined and summarized the outcomes of the data mining process.

RESULTS

The fundamental prescriptions were successfully extracted using the techniques for mining across multiple dimensions. Utilizing the scattered grouping of these prescriptions and with reference to the cluster analysis of the frequency-linked system, the fundamental prescriptions proposed by Professor Xu Zhiyin for addressing thyroid nodules encompass the following ingredients: Glycyrrhiza uralensis Fisch, Cortex Moutan, Paeoniae radix rubra, Curcuma longa L., Radix Curcumae, persica seed, Citri Reticulatae Viride Pericarpium, Pinellia ternata, Spica Prunellae, Ostreae concha, Gleditsia sinensis spine, Tuckahoe and Radix Codonopsis.

CONCLUSION

The fundamental prescriptions were acquired using the frequency approach, association rule technique, k-means clustering approach, and systematic clustering approach. The research findings corroborate one another, demonstrating that Professor Xu Zhiyin's approach to distinguishing and treating thyroid nodules is embodied in distinct prescriptions tailored to specific diseases.

Radiofrequency Ablation for Benign Thyroid Nodules

CONTEXT

Thermal ablative techniques of the thyroid have recently gained clinical traction as a therapeutic alternative that provides symptomatic relief and confers potential advantages over surgery. A truly multidisciplinary technique, thyroid ablation is currently performed by endocrinologists, interventional radiologists, otolaryngologists, and endocrine surgeons. Radiofrequency ablation (RFA), specifically, has seen widespread adoption, particularly in the treatment of benign thyroid nodules. This review summarizes current evidence on the application of RFA in benign thyroid nodules, and provides a start to finish overview of procedural preparation, performance, and outcomes.

EVIDENCE ACQUISITION

A narrative review of literature focusing on RFA in the treatment of benign nodular disease was performed. Emphasis was placed on consensus statements, best practice guidelines, multi-institutional studies, and systematic reviews to summarize key concepts in candidacy, techniques, expectations, and outcomes.

FINDINGS

RFA is increasingly recognized as a first-line treatment strategy in the management of symptomatic nonfunctional benign thyroid nodules. It can also be considered in functional thyroid nodules with small volumes or in patients ineligible for surgery. A targeted and efficacious technique, RFA results in gradual volume reduction that preserves the function of the surrounding thyroid parenchyma. Proper procedural technique, proficiency in ultrasound, and experience in ultrasound-guided procedures are instrumental to maintaining low complication rates and achieving successful ablation outcomes.

CONCLUSIONS

In pursuit of a personalized approach, physicians across disciplines are increasingly incorporating RFA into their treatment algorithms, most commonly for benign nodules. As with any intervention, thoughtful selection and implementation ensure a safe procedure with optimal patient benefit.

Ethanol ablation of thyroid cysts in the young with a focus on efficacy and quality of life

Objective

Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is used in patients with recurrent symptomatic thyroid cysts as a credible alternative to surgery. Young patients commonly do not wish to undergo surgery and prefer ethanol ablation, if available. The effect of this approach on quality of life is an essential factor in deciding on the treatment options, especially in the young with a long life expectancy and no comorbidity.

Methods

We performed US-PEIT in a cohort of young patients, 15-30 years, from 2015 to 2020. The patients' general quality of life (QoL), self-reported compression symptoms and neck appearance were evaluated.

Results

The cohort comprised 59 patients with 63 cysts, more women than men, with a mean age of 23.8 years. About 1.5 mL of injected alcohol were needed to reach a 90.7% mean cyst volume reduction ratio in 12 months. The method did not fail in any of the patients; a single US-PEIT session was undertaken in 46% of them. The procedure significantly improved each of the patients' symptoms with a significant total score difference (P < 0.001). The total symptom score correlated with the initial cyst volume (P = 0.002; r = 0.395). The mean QoL score by SF-36 6 months after the last US-PEIT was significantly different for physical component summary 56.5 (P < 0.001) but not different for mental component summary 47.7 (P = 0.125), compared to age-corresponding norms.

Conclusions

US-PEIT is a safe and effective method for the young, leading to improvements in cosmetic and subjective complaints, and should also be considered as first-line treatment in the young.

Efficacy of radiofrequency and laser thermal ablation in solving thyroid nodule-related symptoms and cosmetic concerns. A systematic review and meta-analysis

Several studies have showed good/excellent results of thermal-ablation (TA) to reduce volume of benign thyroid nodule (TN). Nevertheless, no systematic review has reported information about clinical achievements with TA. Being the latter of high interest, this systematic review was undertaken to achieve high evidence about the efficacy of TA in reducing TN-related symptoms and cosmetic concerns. Radiofrequency (RFA) and laser (LA) therapies were considered. A comprehensive literature search of online databases was performed on January 2022 looking for studies reporting clinical results obtained by RFA or LA in terms of VAS (namely, Visual Analogic Scale) and cosmetic concerns. Initially, 318 records were found and 14 were finally included in the meta-analysis. VAS data were available in all RFA studies and the pooled mean reduction was of 3.09 points with significant heterogeneity. Cosmetic score data were available in 11 RFA studies and the pooled mean reduction was of 1.45 with significant heterogeneity. Regarding LA studies, 4 series reported VAS data and the pooled mean reduction was of 2.61 points with significant heterogeneity. The analysis of LA data about cosmetic concerns was not performed due to data paucity. Importantly, heterogeneities were not explained by meta-regression analyses using several covariates (i.e., baseline TN volume, follow-up duration, volume reduction rate). This systematic review showed that clinical data about TN TA efficacy are sparse and affected by high unexplained inconsistency. International societies should give indication about how we should clinically select and evaluate patients undergoing TN TA.