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Radiofrequency Ablation of Thyroid Nodules
[edit]Radiofrequency ablation (RFA) has been used successfully on benign thyroid nodules for decades, most notably in Europe, South America and Korea. In the United States, the FDA approved the use of RFA techniques for thyroid nodules in 2018. Since then, professional guidelines reflect its use as a viable treatment modality for thyroid nodules, and the popularity of the procedure is increasing. As of 2021 there were only approximately 70 clinicians nationwide that would offer the procedure, mostly endocrinologists.
Today, numerous large institutions have integrated this into their practice, and there is a growing movement of patients devoted to the concept of "save the thyroid.
Timeline of Thyroid RFA in the United States:
- 2023: American Thyroid Association issued the position statement "Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. [1]
- 2022: The American Association of Clinical Endocrinologists publishes an update in Endocrine Practice, stating that the "new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses" [2]
- 2018: FDA approves the RFA procedure for treatment of benign thyroid nodules.
- 2015: The American Association of Clinical Endocrinologists published in Endocrine Practice [3] about the use of RFA for thyroid nodules.
Procedure
The procedure is similar to a thyroid biopsy, though instead of using a needle to remove cells from the nodule, a probe delivers heat to the interior of the nodule that effectively "cooks" the tissue from the inside out. Over the course of 3-6 months, the nodule will continue to shrink typically achieving a 50-80% reduction total size.
In order to qualify for an RFA procedure, a patient must have a clearly benign thyroid nodule, usually proven by two fine needle aspiration biopsies. There are some other conditions that would prevent a patient from undergoing RFA, and this should be discussed in detail with an RFA provider.
At this time, RFA is not recommended for the treatment of malignant thyroid nodules, though research into this topic is ongoing [4][5].
Citations:
- ^ Sinclair CF, Baek JH, Hands KE, Hodak SP, Huber TC, Hussain I, Lang BH, Noel JE, Papaleontiou M, Patel KN, Russ G, Russell J, Spiezia S, Kuo JH. General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement. Thyroid. 2023 Oct;33(10):1150-1170. doi: 10.1089/thy.2023.0281. Epub 2023 Sep 14. PMID: 37642289; PMCID: PMC10611977.
- ^ Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, Condon E, Henrichsen T, Itani M, Papaleontiou M, Rangel L, Schmitz J, Stan MN. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract. 2022 Apr;28(4):433-448. doi: 10.1016/j.eprac.2022.02.011. PMID: 35396078.
- ^ Radiofrequency Ablation for Benign Thyroid Nodules - A Look Towards the Future of Interventional Thyroidology Lupo, Mark A. Endocrine Practice, Volume 21, Issue 8, 972 - 974
- ^ Rangel L, Volpi LM, Stabenow E, Steck JH, Volpi E, Russell JO, Tufano RP. Radiofrequency for benign and malign thyroid lesions. World J Otorhinolaryngol Head Neck Surg. 2020 Sep 19;6(3):188-193. doi: 10.1016/j.wjorl.2020.07.002. PMID: 33073215; PMCID: PMC7548387.
- ^ Rangel LG, Steck JH, Volpi EM, Russell JO, Tufano RP. Radiofrequency Ablation of Papillary Thyroid Microcarcinomas. AACE Clin Case Rep. 2022 Feb 16;8(2):99-101. doi: 10.1016/j.aace.2022.02.005. PMID: 35415224; PMCID: PMC8984508.