Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
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THYROID NODULES
Ultrasound-guided thermal ablation of thyroid nodules— what do the experts say about who, what, and when?
BACKGROUND
Thyroid nodules are the most common endocrine disorder, as up to 50% of the US population will have a thyroid nodule after imaging that includes the thyroid. Evaluation of thyroid nodules currently include thyroid ultrasound and thyroid biopsy. Nodules that are cancerous are usually removed by surgery, as are large benign nodules.
Alternative treatments to surgery for thyroid nodules are continually being developed. These techniques involve inserting needles into the nodule through the skin to deliver either substances, sound waves or current to destroy and/or shrink nodule (ablation). The newest one to generate a lot of interest is radiofrequency (RFA) ablation that uses current to generate heat to destroy cells. Other techniques to shrink thyroid nodules outside of surgery include injecting ethanol into the nodule (ETOH ablation), microwave ablation, laser ablation and highintensity focused ultrasound (HIFU) ablation.
An international collaborative panel comprising surgeons, endocrinologists, and radiologists with expertise in ultrasound-guided ablation got together to discuss the indications, techniques, complications, expectations of successful treatments, and recommended follow-up of thyroid nodules treated with non-surgical ablation. The goal was to develop a best practice manual of thyroid ablation techniques, including the indications for the different thyroid nodule ablation techniques, their best use, and reported outcomes.
THE FULL ARTICLE TITLE
Orloff LA et al 2021 Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 44:633–660. PMID: 34939714.
SUMMARY OF THE STUDY
This consensus statement was based on the review of 690 sentinel articles by a group of clinicians with expertise in thyroid ablation techniques. Five techniques (ETOH, microwave, laser, RFA, and HIFU ablation) were reviewed to assess their common indications, ideal candidates, and specific advantages and disadvantages. Complications and issues related to starting these technologies in a clinical thyroid practice were discussed.
In general, the indications for the use of these treatments included overactive thyroid nodules, non-cancerous large compressive goiters and certain small thyroid cancers. Overall, 18 recommendations were proposed, representing panel-supported, evidence-based statements to guide providers considering starting to use this technology. These recommendations include clear indications, pretreatment considerations, and technical suggestions for performing these ultrasound-guided ablative therapies for thyroid nodules. The recommendations also contain expectations from treatments, complications and ways to measure successful treatment. Longer-term follow-up recommendations and indications for retreatments are stated, as well.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Ultrasound-guided ablation for thyroid nodules are rapidly growing as a possible treatment option, including in patients who may have otherwise undergone thyroid surgery. This consensus statement by an international group of experts provides 18 recommendations for their use. Experience in ultrasound and procedural assessment and follow-up are important components for their successful incorporation into a clinical thyroid practice.
— Alan P. Farwell, MD
ATA THYROID BROCHURE LINKS
Thyroid Nodules: https://www.thyroid.org/thyroid-nodules/
ABBREVIATIONS & DEFINITIONS
Goiter: a thyroid gland that is enlarged for any reason is called a goiter. A goiter can be seen when the thyroid is overactive, underactive or functioning normally. If there are nodules in the goiter it is called a nodular goiter; if there is more than one nodule it is called a multinodular goiter.
Thyroid nodule: an abnormal growth of thyroid cells that forms a lump within the thyroid. While most thyroid nodules are non-cancerous (Benign), ~5% are cancerous.
Thyroid Ultrasound: a common imaging test used to evaluate the structure of the thyroid gland. Ultrasound uses soundwaves to create a picture of the structure of the thyroid gland and accurately identify and characterize nodules within the thyroid. Ultrasound is also frequently used to guide the needle into a nodule during a thyroid nodule biopsy.
Radiofrequency ablation (RFA): a nonsurgical, minimally invasive technique that uses alternating electromagnetic current to generate heat to destroy cancer cells.
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