Radiofrequency Ablation of Benign Thyroid Nodules

Benign thyroid nodules are common in the general population with a prevalence estimated to be more than 50% by autopsy studies.[1] [2] They are also a common incidental finding on imaging studies with one prospective study identifying nodules by ultrasound in 67% of patients examined, and are more commonly found in women than in men.[3] Benign thyroid nodules are more common and often more numerous in older patients.[4]

Benign nodules can be classified as nonfunctional or autonomously functioning thyroid nodules (AFTNs). The latter contain gain-of-function mutations of the thyroid-stimulating hormone receptor gene that cause permanent activation, and can result in subclinical or clinical hyperthyroidism.[5] As benign thyroid nodules grow, they can become symptomatic from compression of adjacent structures. Depending on location symptoms can manifest as difficulty swallowing, shortness of breath, chronic cough, globus sensation, fullness, pressure, or hoarseness. Often symptoms are exacerbated by turning the head or lying down.

In the United States, surgery has been the standard therapy for benign thyroid nodules that cause compressive symptoms, with approximately 150,000 hemithyroidectomies or total thyroidectomies being performed each year for benign thyroid disease.[6] AFTNs can also be treated with radioactive iodine (RAI).[7] Both surgery and RAI have significant impact on patients' quality of life. Surgery requires general anesthesia, hospitalization, and can result in postoperative hypothyroidism in approximately one-third of patients.[8] [9] RAI requires a degree of isolation after administration and can also result in postablative hypothyroidism.

Radiofrequency ablation (RFA) offers patients a minimally invasive alternative to surgery for symptomatic benign thyroid nodules. Thyroid nodule RFA has been shown to be safe and effective in multiple large, long-term studies in Asia and Europe,[10] [11] [12] [13] and is now growing rapidly in the United States.[14] [15] While the general principles of thyroid ultrasound and percutaneous RFA are familiar to interventional radiologists, there are nuances that are important for safe and effective treatment. This article will focus on RFA of benign thyroid nodules, specifically the relevant anatomy, procedural techniques, and patient management so that interested interventional radiologists are able to adopt this procedure into practice.

Publikationsverlauf

Artikel online veröffentlicht:
10. August 2021

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