Monopolar radiofrequency ablation of thyroid nodules: a prospective Austrian single center study.

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Monopolar radiofrequency ablation of thyroid nodules: a prospective Austrian single center study.

Thyroid. 2018 Feb 28;:

Authors: Dobnig H, Amrein K

Abstract
Background Monopolar radiofrequency ablation is currently deemed an exotic treatment option for benign thyroid nodules in many central European countries. The aim of this study was to prospectively evaluate safety and efficacy of this method in a large patient cohort following its introduction in Austria. Patients and methods Peri- and post-interventional complications were analyzed for 277 patients. Efficacy was determined for 300 and 154 nodules at, respectively, 3 and 12 months post-treatment. All treatments were performed with an internally-cooled 18G radiofrequency electrode using a free-hand, so-called "moving-shot" technique following subcutaneous and local perithyroidal anesthesia. Results Mean patient age (SD) was 52±12.9 years (75% female) and overall mean baseline nodule volume (SD) was 13.8±15.9 ml. 62.8% of patients had visible nodules, 40% a symptom score ≥4 on a 10-point visual analogue scale and 14.4% hyperthyroidism. Mean overall nodule volume reduction rates (VRR) at 3 and 12-months were, respectively, 68±16% and 82±13% (all P<0.001). At 12 months, 81% of nodules exhibited a VRR of ≥70%, with 10, 6 and 2% of nodules showing VRRs of, respectively, 60-70, 50-60 and ≤50%. Subgroup analysis according to baseline nodule size (≤10 ml to >30 ml) or baseline nodule composition (solid, mixed, cystic), revealed significantly higher VRRs for smaller and cystic nodules. Nodule shrinkage was, moreover, accompanied by significantly improved symptom and cosmetic scores after 3 and 12 months (all P<0.001). Of 32 hyperthyroid patients, 27 were euthyroid (84%), 4 had subclinical hyperthyroidism and one subclinical hypothyroidism at last follow-up. Post-procedural complications were absent in 83% of patients, minimal in 12.9%, moderate and reversible in 3.2% (1.8% voice change, 0.7% hyperthyroidism, 0.3% wound infection treated with antibiotics, 0.3% epifascial hematoma) and irreversible in 0.7% (one case with hypothyroidism and one with a wound infection treated by surgery). Conclusions We conclude that a single treatment course with monopolar RFA is both safe and highly effective in terms of nodule volume reduction, relief of local symptoms and (in patients with hyperthyroidism) restoration of euthyroid function. In no case was a prescription of thyroid medication required amongst those patients that were euthyroid at baseline.

PMID: 29490593 [PubMed - as supplied by publisher]

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