Efficacy of radiofrequency ablation in autonomous functioning thyroid nodules. A systematic review and meta-analysis
Whether thermal ablation is effective to treat toxic thyroid nodules (TTN) is still unknown. Aim of this review was to achieve more robust evidence on the efficacy of radiofrequency ablation (RFA) in treating TTN in terms of TSH normalization, thyroid scintiscan, and volume reduction rate (VRR). A comprehensive literature search of PubMed/Medline and Scopus was performed in November 2018 to retrieve published studies. Original papers reporting TTN treated by RFA and later followed-up were eligible. Excluded were: articles not within this field, articles with unclear data, overlapping series, case/series reports. Discordances were solved in a final collegial meeting. Information was collected concerning population features, treatment procedure, follow-up, cases with TSH normalization, cases with scintiscan normalization, VRR of nodules. Pooled prevalence of patients with TSH or scintiscan normalization, and pooled VRR over time were calculated. For statistical analysis, the random-effects model was used. Eight articles published between 2008 and 2018 were included. The overall number of AFTN treated by RFA was 205. Five studies used a single session of treatment. The time of follow-up ranged from six to 24 months. The pooled rate of patients with TSH normalization was 57%. The pooled rate of patients with scintigraphically proven optimal response was 60%. The pooled VRR at 1 year was 79%. Baseline nodules volume was associated with the rate of TSH normalization. In conclusion, a moderate efficacy of RFA in treating TTN was found, and this can represent a solid starting point in this field.
KeywordsRadiofrequency ablation Autonomous functioning thyroid nodules
Autonomously functioning thyroid nodules
Percutaneous ethanol injection
Toxic thyroid nodules
Volume reduction rate
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules 2016. Endocr Pract. 2016;22:622–39.CrossRefGoogle Scholar
- 9.Kim JH, Baek JH, Lim HK, Ahn HS, Baek SM, Choi YJ, et al. Guideline Committee for the Korean Society of thyroid radiology (KSThR) and Korean Society of Radiology. 2017 thyroid radiofrequency ablation guideline: Korean society of thyroid radiology. Korean J Radiol. 2018;19(4):632–55.CrossRefGoogle Scholar
- 12.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. https://doi.org/10.1136/bmj.b2700.CrossRefGoogle Scholar
- 14.Deandrea M, Limone P, Basso E, Mormile A, Ragazzoni F, Gamarra E, et al. US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol. 2008;34(5):784–91. https://doi.org/10.1016/j.ultrasmedbio.2007.10.018.CrossRefGoogle Scholar
- 20.Cesareo R, Naciu AM, Iozzino M, Pasqualini V, Simeoni C, Casini A, et al. Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int J Hyperth. 2018;34(5):617–23. https://doi.org/10.1080/02656736.2018.1430868.CrossRefGoogle Scholar
- 30.Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hypert. 2017;33:920–30.Google Scholar