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

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.