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Comparative Study
. 2015 Jul;36(7):1321-5.
doi: 10.3174/ajnr.A4276. Epub 2015 Mar 26.

Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation

Y Che  1 , S Jin  2 , C Shi  3 , L Wang  4 , X Zhang  4 , Y Li  5 , J H Baek  6
Affiliations
Comparative Study

Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation

Y Che et al. AJNR Am J Neuroradiol. 2015 Jul.

Abstract

Background and purpose: Nodular goiter is one of the most common benign lesions in thyroid nodule. The main treatment of the disease is still the traditional surgical resection, however there are many problems such as general anesthesia, surgical scar, postoperative thyroid or parathyroid function abnormalities, and high nodules recurrence rate in residual gland. The purpose of this study was to compare the efficacy, safety, and cost-effectiveness of 2 treatment methods, surgery and radiofrequency ablation, for the treatment of benign thyroid nodules.

Materials and methods: From May 2012 to September 2013, 200 patients with nodular goiters who underwent surgery (group A) and 200 patients treated by radiofrequency ablation (group B) were enrolled in this study. Inclusion criteria were the following: 1) cosmetic problem, 2) nodule-related symptoms, 3) hyperfunctioning nodules related to thyrotoxicosis, and 4) refusal of surgery (for group B). An internally cooled radiofrequency ablation system and an 18-ga internally cooled electrode were used. We compared the 2 groups in terms of efficacy, safety, and cost-effectiveness during a 1-year follow-up.

Results: After radiofrequency ablation, the nodule volume decreased significantly from 5.4 to 0.4 mL (P = .002) at the 12-month follow-up. The incidence of complications was significantly higher from surgery than from radiofrequency ablation (6.0% versus 1.0%, P = .002). Hypothyroidism was detected in 71.5% of patients after surgery but in none following radiofrequency ablation. The rate of residual nodules (11.9% versus 2.9%, P = .004) and hospitalization days was significantly greater after surgery (6.6 versus 2.1 days, P < .001), but the cost difference was not significant.

Conclusions: Surgical resection and radiofrequency ablation are both effective treatments of nodular goiter. Compared with surgery, the advantages of radiofrequency ablation include fewer complications, preservation of thyroid function, and fewer hospitalization days. Therefore, radiofrequency ablation should be considered a first-line treatment for benign thyroid nodules.

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Figures

Figure.
Figure.
A 50-year-old woman with left-neck discomfort. A, Before treatment, a 3-cm solid, left thyroid nodule is evident. B, During the RF ablation, the electrode (arrows) is placed within the nodule. C, Six months after RF ablation, the treated nodule (arrows) has decreased considerably in size and measures only 8 mm.
See this image and copyright information in PMC

Comment in

  • Is Radiofrequency Ablation an Alternative to Thyroidectomy?
    Tez S, Tez M. Tez S, et al. AJNR Am J Neuroradiol. 2015 Sep;36(9):E60. doi: 10.3174/ajnr.A4466. Epub 2015 Jul 16. AJNR Am J Neuroradiol. 2015. PMID: 26185323 Free PMC article. No abstract available.
  • Reply: To PMID 25814656.
    Baek JH. Baek JH. AJNR Am J Neuroradiol. 2015 Sep;36(9):E61. doi: 10.3174/ajnr.A4479. Epub 2015 Jul 16. AJNR Am J Neuroradiol. 2015. PMID: 26185329 Free PMC article. No abstract available.
  • REPLY.
    Che Y. Che Y. AJNR Am J Neuroradiol. 2016 Jan;37(1):E9-10. doi: 10.3174/ajnr.A4612. Epub 2015 Nov 19. AJNR Am J Neuroradiol. 2016. PMID: 26585265 Free PMC article. No abstract available.
  • Risk of Malignancy in Symptomatic Nodular Goiter Treated with Radiofrequency Ablation.
    Yang L, Tang H, Lee AM, Zou Y, Huang X, Tang X, Bai HX. Yang L, et al. AJNR Am J Neuroradiol. 2016 Jan;37(1):E7-8. doi: 10.3174/ajnr.A4580. Epub 2015 Nov 19. AJNR Am J Neuroradiol. 2016. PMID: 26585266 Free PMC article. No abstract available.

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