Effectiveness of Injecting Cold 5% Dextrose into Patients with Nerve Damage Symptoms during Thyroid Radiofrequency Ablation

Abstract

Background: Although radiofrequency ablation (RFA) is a safe treatment for thyroid tumors, nerve damage is a frequent complication. A previous retrospective study suggested that an injection of cold 5% dextrose in water (5% DW) can reduce nerve damage during RFA. This study validated the efficacy of injecting cold 5% DW for management of nerve damage during RFA.

Methods: Between November 2017 and December 2018, 242 patients underwent 291 RFA sessions for treatment of benign thyroid nodules or recurrent thyroid cancers. Using a standardized technique, cold (0°C to 4°C) 5% DW was immediately injected around the damaged nerve into patients with any symptoms suggesting nerve damage. The incidence of nerve damage, the volume of 5% DW injected, symptom recovery time and the incidence of permanent nerve damage were evaluated.

Results: Nineteen patients experienced nerve damage symptoms related to 21 RFA sessions, including 17 patients during 19 sessions and two patients on the day after two sessions. Patients with nerve damage symptoms detected during RFA were treated by injection of a mean 41 mL (range, 3 to 260) cold 5% DW, but the two patients who experienced symptoms the next day did not receive cold 5% DW injections. Immediate recovery was observed after 15 RFA sessions in 14 patients. No patient experienced permanent nerve damage.

Conclusion: Injection of cold 5% DW is effective in managing nerve damage during RFA of thyroid lesions.

Keywords: Radiofrequency ablation; Ultrasonography; Thyroid nodule.

Fig. 1

(A) Ultrasonography showing a benign thyroid nodule (1.7×3.8×4.5 cm) in the left isthmic thyroid gland. (B) Radiofrequency electrode with a 1 cm sized active tip located within the nodule for ablation. (C) During ablation, the patient complained of voice changes; ablation was immediately stopped and cold 5% dextrose water was injected into the left tracheoesophageal groove. (D) After injection of 20 mL cold 5% dextrose water, the voice change was completely relieved.

Fig. 2

Study flow diagram. There are four major complications, including three in the recurrent laryngeal nerves and one in the spinal accessory nerve. RFA, radiofrequency ablation; DW, dextrose water. ^aSession based percentage.