Identify candidates and preprocedure workup for benign nonfunctioning and autonomously functioning nodules.
Perform trans-isthmic, moving-shot radiofrequency ablation (RFA) with clear intraprocedural endpoints.
Apply protective maneuvers and a structured follow-up pathway to minimize complications and regrowth.
Background: Ultrasound-guided RFA provides a thyroid-sparing option for symptomatic benign nodules and for autonomously functioning nodules when surgery or radioiodine are undesirable. Consistent outcomes include substantial volume reduction, preservation of thyroid function, and low major-complication rates. This exhibit emphasizes patient selection, technical execution, and reproducible endpoints rather than hypothesis-driven data.
Clinical Findings/Procedure Details: Selection: For nonfunctioning nodules, obtain two concordant benign cytology or core results, with rare exceptions for classic benign sonographic patterns. For autonomously functioning nodules, one benign cytology may suffice with scintigraphic confirmation. Record baseline symptom (0-10) and cosmetic (1-4) scores, thyroid function tests, and detailed ultrasound mapping.
Technique: Use local perithyroidal lidocaine. Choose a trans-isthmic trajectory to stabilize the electrode and shield the tracheoesophageal groove. Apply a moving-shot approach from deep to superficial compartments. Perform hydrodissection with cold 5% dextrose to separate the nodule from critical structures. Prefer short active-tip electrodes near neural corridors. Treat feeding and draining vessels deliberately when present. Intraprocedural endpoints include uniform transient hyperechogenicity, loss of Doppler flow, and a continuous peripheral hyperechoic rim.
Follow-up: Reassess with ultrasound and labs at 1-3, 6, and 12 months, then annually. Track volume reduction rate; >=50% at 12 months commonly reflects clinical success. Consider reablation for residual vascularity, regrowth, or persistent symptoms.
Conclusion and/or Teaching Points: RFA achieves durable debulking and symptom relief while preserving thyroid function when five principles are followed: trans-isthmic access, systematic moving-shot sequencing, hydrodissection with short tips near critical structures, deliberate treatment of venous and arterial channels, and standardized endpoints plus surveillance. Select ethanol ablation for predominantly cystic nodules and RFA for solid or mixed nodules, using staged or combined approaches when appropriate.
