Percutaneous benign thyroid nodule thermal ablation: a single-center retrospective observational study from a United States perspective

Percutaneous benign thyroid nodule thermal ablation is an increasingly utilized procedure to treat symptomatic thyroid nodules. Studies in Italy and Korea are robust, but United States data is sparse. This study evaluates the efficacy of percutaneous benign thyroid nodule ablation in a United States setting measured by symptom resolution and volume reduction.

Materials and Methods:

This retrospective cohort study (5/12/2021 - 8/7/2024) includes patients treated with ultrasound-guided radiofrequency (RFA) or microwave ablation (MWA) (both HS Hospital Service AMICA, Italy) for symptomatic benign thyroid nodules. Candidacy was determined by endocrinologists and radiologists. All procedures used the moving shot technique. Routine follow-up was at 6 months. Wilcoxon and Fisher’s exact tests evaluated size associations with symptom resolution.

Results:

60 consecutive patients (mean age = 54.72 ± 14.32 years; 55 females; average nodule volume 29.98 ± 29.06 cm^3) were identified and included. Common symptoms included cosmetic deformity (74.6%), dysphagia (59.3%), dysphonia (25.0%), and hyperfunctioning nodule (13.6%). Of the 60 patients, 37 completed 6- or 12-month follow-up. 81% (30/37) reported full symptom resolution. Among all follow-ups, mean volume reduction post-RFA was 11.72 ± 12.13 cm^3 and relative mean volume reduction was 51.8 ± 30.2%. Percent volume reduction was significantly associated with symptom resolution (56.4% reduction in successful cases vs 21.8% reduction in unsuccessful cases, p = 0.015). Stratified by resolution of symptoms, the starting nodule volume was slightly smaller in successful than unsuccessful cases (30.07 cm^3 vs 35.07 cm^3, p=0.717). There was one minor bleeding complication.

Conclusion: We demonstrate that ultrasound-guided percutaneous benign thyroid nodule thermal ablation can safely and effectively improve common mass effect symptoms in a United States clinic, comparable to studies from other countries, though our cohort suggests that patients with larger nodule volumes and a tendency to decline follow-up may be more likely to seek thermal ablation in the United States than in the published international literature.