RADIOFREQUENCY ABLATION OF A LARGE THYROID NODULE
Fig. 1. Photos of the patient’s neck before (a) and 10 months after (b) radiofrequency ablation (RFA) of a large, benign, thyroid nodule.
Fig. 2. Ultrasound images in B-Mode showing the thyroid nodule before (a) and 10 months after (b) radiofrequency ablation.
A 29-year-old Caucasian female was referred to our Endocrinology Unit by her general practitioner (GP) because of a slowly enlarging neck mass. The patient mentioned that she had noticed a lump of the anterior neck becoming larger over time and causing her progressively esthetic concerns and swallowing problems. The patient’s GP, after having palpated her neck, suspected a thyroid mass. In our clinic we performed a thyroid ultrasound scan and found a predominantly solid, isoechoic, heterogeneous, thyroid nodule (TN) of the right lobe with regular margin 3.49 cm thick x 3.93 cm wide x 5.95 cm long (volume of 42.44 mL). Patient’s neck at the time of presentation and B-mode ultrasound image (transverse view) of the patient’s TN are shown in Figures 1a and 2a respectively. TSH blood level was 1.25microIU/mL (normal). Consequently, the patient underwent a fine-needle aspiration biopsy that revealed a benign Bethesda II class thyroid nodule. Since the TN was symptomatic we offered to the patient two treatment options: a. right surgical thyroid lobectomy or b. ultrasound-guided (UG) thyroid radiofrequency ablation (RFA) (1). The patient refused surgery and underwent UG monopolar RFA. We used a VIVA RF generator (STARmed, Seoul, Republic of Korea) connected to a star RF Fixed electrode (STARmed, Seoul, Republic of Korea). This electrode needle is straight, internally cooled, 7-cm-long, 18-gauge, and we chose a model with an active tip of 1.0 cm which actually is suitable for ablation of medium- and large-size TNs (2). The ablation was performed with a transisthmic approach according to the moving shot technique (3).
Ten months after thyroid RFA the patient’s neck and B-mode ultrasound image (transverse view) of the patient’s TN appeared as shown in Figures 1b and 2b respectively. The patient reported complete resolution of esthetic and compressive problems. Indeed, the TN shrunk to 1.81 cm thick x 2.54 cm wide x 3.08 cm long (volume of 7.36 mL), resulting in a volume reduction percentage of 82.66%.
Take home message:
Thyroid RFA is a valid alternative to surgery in the treatment of symptomatic benign thyroid nodular disease when surgery is refused or contraindicated. This treatment is performed in an interventional suite under conscious sedation and with local anesthesia. There is no need of hospital admission and the patient can return home on the same day of the ablation. In conclusion, monopolar thyroid RFA is an effective and safe treatment for debulking benign symptomatic TNs.