Study presented at the American Thyroid Association 2021
Thyroid RFA should be a first line therapy for benign thyroid nodules. Three endocrinologists present their RFA treatment results on 73 cases treated in outpatient thyroid practices in San Antonio, TX, Kathleen Hands, Santa Monica, CA, Richard Guttler and Gettysburg, PA Brian Michael .
Patients were vetted for benign class II thyroid nodules. Volume of the target nodule was done pre-RFA and after. Symptom and cosmetic scores were collected pre and post RFA. Local Lidocaine injection of the skin and hydro-dissection of thyroid capsule prevents discomfort. Hydro-dissection technique with dextrose infusion was used when vital structure was near the target nodule. Method of ablation was moving shot technique. RF Medical Korea generator with 7 cm, 18 G electrode with cooling pump was used. The procedure takes under an hour, with actual RFA time varying from 7-22 minutes. 1,3, and 6 months post procedure follow-up ultrasounds were performed to gather data on efficacy. On average, nodules greater than 4.5 cm required 2 procedures to obtain desired results.
The nodules decreased in size an average 48% at 1 month and 82% at 3 months in more than 80% cases. Larger goiters requiring more than one procedure were removed from these calculations. Symptom and cosmetic scores improved substantially and usually entirely. Except for post procedure local discomfort relieved with Tylenol and ice, there were no other minor complications and no major complications. One patient needed a Medrol dose pack to help with her neck swelling and discomfort. To date, all TFT’s remained stable and none developed hypothyroidism. Of the 12 hot nodules treated, 8 are off anti-thyroid medication.
Thyroid RFA is a procedure easily learned by ECNU certified endocrinologists who are well adapted to performing their own ultrasounds, FNAs, and PEI. No surgery was necessary in the 73 cases, all preserved baseline thyroid function, With no major complications supporting safety. No down time, no surgical scar, fraction of the cost for surgery, and no general anesthesia.
In conclusion this preliminary study of 73 patients shows how Thyroid RFA is safe and efficacious when performed in an endocrine outpatient office practice.
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