BACKGROUND
Thyroid nodules are very common and can be found in more than half of the population in the United States. While most of the nodules do not create any problems, about 5% could be cancer and need surgery. Benign (not cancer) nodules can cause trouble if they grow large enough to cause discomfort either due to compression or their appearance. Another situation that can be harmful is when the nodule makes too much thyroid hormone, causing hyperthyroidism. In these situations, the nodules are treated with surgery or radioactive iodine therapy. Both treatments have some risks. They can result in hypothyroidism and lifelong thyroid hormone replacement with a pill may be needed. Surgery would also leave a scar and sometimes it can cause changes in voice.

In the recent years several new treatment options have been successfully used to treat thyroid nodules, especially in Europe, Asia, and South America. One of these methods is radiofrequency ablation (RFA). A thin needle is inserted into the nodule under ultrasound guidance and an electrical current passes through the needle generating heat which burns the cells inside the nodule. The treated nodule shrinks and turns into scar tissue. It can be done in the doctor’s office without putting the patient to sleep with general anesthesia. This treatment was approved as a non-surgical option for treatment of benign thyroid nodules several years ago but has not been widely available in the United States.

In this study, the authors report the largest outpatient experience regarding the effectiveness and safety of RFA for the treatment of benign thyroid nodules performed without general anesthesia in the United States.

THE FULL ARTICLE TITLE
Hussain I et al 2021 Safety and efficacy of radiofrequency ablation of thyroid nodules—Expanding treatment options in the United States. J Endocr Soc 5(8):bvab110.

SUMMARY OF THE STUDY
This study was done by reviewing the charts of patients who had RFA for their thyroid nodules at The Thyroid Clinic in Salt Lake City, Utah between November 2018 and January 2021. All patients had a physical exam, blood tests for thyroid function, and thyroid ultrasound before the procedure. Patients who had suspicious findings on the ultrasound had a thyroid biopsy. Patients who had metal hardware/pacemaker, pregnancy, or suspicious results on fine-needle aspiration biopsy were not treated with RFA procedure. The nodules that were producing too much thyroid hormone causing hyperthyroidism (autonomous function, AFTN) and nodules that were mostly solid and were bothersome due to their size causing pressure in the neck and choking symptoms or cosmetic concerns, (nonfunctional, NFTN), were treated with RFA. Treatment was considered successful if the nodule size decreased more than 50% within 6 months or if symptoms improved for NFTN or if thyroid hormones levels returned to normal for AFTN within 12 months of RFA treatment.

A total of 53 patients had RFA for 58 nodules and 42 patients were present for follow up evaluations after RFA treatment. Of these, 23 nodules were NFTN and 24 were AFTN. The average decrease in size was 70% on initial evaluation. The volume of the smaller nodules decreased more than the larger nodules. Thyroid blood tests and hyperthyroid symptoms improved in the nodules making too much thyroid hormone. Thyroid function tests remained normal in the nodules that were treated due to size. There were no major complications. Minor complication rate was 4%, such as small bleeding and temporary change in voice.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
The authors conclude that RFA is a safe and effective treatment option for benign thyroid nodules that cause problems due to their size or function. It has less complications than surgery and radioactive iodine and preserves thyroid function. This study is important for patients since this new treatment method is becoming more available in the United States and may be a good option for treatment of certain thyroid nodules.

— Ebru Sulanc, MD

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