Radiofrequency ablation of benign cold thyroid nodules: Initial clinical experience

Context and objective: To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous radiofrequency (RF) ablation for benign cold thyroid nodules as a nonsurgical therapeutic modality. Design, intervention, and patients: A total of 35 benign cold thyroid nodules in 30 euthyroid patients (M:F = 2:28; mean age 39.1 years) underwent percutaneous RF ablation with a 1-cm-internally cooled electrode. Seventy-seven percent (23/30) of patients required conscious sedation for discomfort. We evaluated the tumor size, cystic component, vascularity (by color Doppler US), and the severity of mass-related symptoms before treatment. We assessed the therapeutic efficacy and safety of RF ablation by clinical and US follow-up (median 6.4 months). Main outcome and results: The volume of the tumors before ablation had a range of 0.6-28.2 mL (mean, 6.3 mL). The residual volume was 53.5% +/- 26.5% of original at 1.1-2.9 months (n = 32), 36.2% +/- 27.4% at 3.0-5.9 months (n = 20), 30.7% +/- 25.0% at 6.0-8.9 months (n = 15), and 11.8% +/- 10.9% at 9.0-18.5 months (n = 13). Mixed/mainly cystic tumors showed a significantly better response than mainly solid tumors (p < 0.05). Difference in vascularity did not affect the treatment response. Thyroid function after the procedure was maintained as normal in all patients. Eighty-eight percent of the patients reported an improvement of their symptoms. There was no major complication other than vocal cord palsy in one patient (3.3%). Conclusion: RF ablation may be an effective and safe nonsurgical technique to treat benign cold thyroid nodules.