Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Introduction: Thyroid nodules are exceedingly prevalent. One-half of American adults will have a thyroid nodule detectable by ultrasound by 60 years of age. The vast majority (>90%) of thyroid nodules are benign and are managed conservatively. However, intervention may be required for symptomatic large thyroid nodules causing cosmetic compromise or pressure symptoms. The most common intervention for these symptomatic nodules is surgical, which is associated with significant risks. Over the last two decades, radiofrequency ablation (RFA) for symptomatic thyroid nodules has been practiced internationally. In the USA, after FDA approval in 2019, there have been limited published studies, most of which are conducted in a hospital or tertiary care setting.
Methods: We hypothesized that RFA is effective and can be safely performed in an office setting in the community. A retrospective chart review of all patients who underwent RFA for large benign thyroid nodules between January 1, 2020 and September 21, 2024 was carried out. All procedures were performed in the office under local anesthesia by an Otolaryngologist experienced in thyroid ultrasound interventions. All nodules were benign on cytology by US guided FNA. Post-procedural evaluations with ultrasound were performed at 0-6 months post-RFA (Follow-up #1) and again 6-12 months post-RFA (Follow-up #2). Data were analyzed to determine primary outcome of size reduction and secondary outcome measure of adverse effects.
Results: Twenty-four symptomatic biopsy-proven benign thyroid nodules in 20 patients underwent in-office RFA. The mean age at initial presentation was 51.6 years. The majority of patients were female (66.7%). The average volume of thyroid nodule prompting referral was 31 cm3, with a range of maximum length from 2.5-7.8cm. The mean reduction in thyroid nodule volume at Follow-up #1 was 42.6% (n=17, 95% CI [21.4, 63.8]). Results of paired t-test indicated a significant difference in volume before RFA (mean=52.5, SD=43.8) and at Follow-up #1 (mean=30.7, SD=46.5)(t(17)= 2.3, p=0.03). The mean reduction in thyroid nodule volume at Follow-up #2 was 57.2% (n=16, 95% CI [35.2,79.2]. Results of paired t-test indicated a significant difference in volume before RFA (mean=46.8, SD=39.1) and at Follow-up #2 (mean=13.8, SD=11.5) (t(16)= 3.8, p=0.002). 45% of patients did not report any adverse events. Minor reported adverse events included discomfort (n=4), ecchymosis (n=3), edema (n=2), mild bleeding (n=1), globus sensation (n=1) and low-grade fever (n=1). Rare adverse events included temporary vocal cord paralysis (n=1), infection (n=1), and symptoms of hypothyroidism (n=1).
Conclusions: Treatment with RFA proved efficacious in overall size reduction in benign thyroid nodules. The most reported adverse events were mild, including pain, ecchymosis, edema, and discomfort. One patient had temporary vocal cord paresis, which resolved spontaneously by 3-month follow-up. Another patient experienced skin burn that took 4 weeks to resolve. Our initial experience suggests that RFA can be safely performed in a community office-based setting. This approach can lead to significant cost savings and overall reduced patient anxiety by reducing visits and expediting treatment. However, larger studies with longer follow-up are needed to draw firm conclusions.