Radiofrequency Ablation of Thyroid and Parathyroid Nodules
Thyroid nodules are very common in adults, found in 4–8% by palpation, in 10–41% by ultrasonography (US), and in 50% by pathologic examination at autopsy. Most thyroid nodules are benign. Whereas the majority of nodules do not require treatment, some may need it, for various reasons including pressure symptoms and cosmetic problems. Patients with autonomously functioning thyroid nodules (AFTNs) may have subclinical hyperthyroidism, with approximately 4% per year progressing to obvious hyperthyroidism or thyrotoxicosis. These conditions may have detrimental effects on the skeletal (osteoporosis) and cardiovascular (atrial fi brillation) systems. Large AFTNs may result in clinical problems similar to those of benign cold nodules, such as cosmetic problems and pressure symptoms. Repeat surgery in the central or lateral compartments of the neck may be dif fi cult in patients with recurrent thyroid cancer because previous neck dissection may be associated with high rates of morbidity. Hyperparathyroidism is a major problem in patients with parathyroid nodules. Secondary hyperparathyroidism is caused by chronic dialysis in patients with chronic renal failure. Long-standing hyperparathyroidism causes cardiovascular disease, hypertension, renal stones, osteoporosis, and bone pain. Large parathyroid nodules may cause neck discomfort and cosmetic problems.
RF ablation is a minimally invasive technique and a valuable alternative to surgery in treatment of benign cold thyroid nodules and AFTNs.
RF ablation of recurrent thyroid cancers and in treatment of hyperparathyroidism may be an alternative to surgery in patients at high surgical risk.
Use of the trans-isthmic approach and the moving shot technique are essential to ablate ellipsoid thyroid nodules completely, and to avoid thermal damage to surrounding critical structures.
Knowledge of critical structures around the targeted lesion, and possible associated complications, is important for safe ablation.
RF ablation of benign cold thyroid nodules shows excellent short-term results, reducing nodule volume, nodule-related symptoms, and cosmetic problems
RF ablation of AFTNs and functioning parathyroid nodules is effective to improve function and to reduce the volume of treated nodules.
RF ablation affords excellent locoregional control of recurrent thyroid cancers.
KeywordsThyroid Nodule Recurrent Laryngeal Nerve Phrenic Nerve Benign Thyroid Nodule Cosmetic Problem
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