STUDY OF RADIOFREQUENCY ABLATION OF THYROID NODULE
AND COMPARISON OF RADIOFREQUENCY ABLATION WITH THYROIDECTOMY.
PRADEEP KUMAR, WANG SHU RANG,
ABSTRACT:-
Background and Purpose:- benign thyroid nodule is one of the most common thyroid disorder. The main treatment of thyroid nodules is traditional surgical resection, however there are many problems such as General Anesthesia, surgical scar, post-operative thyroid or parathyroid functions abnormalities, and high nodule recurrence in residual gland.
The purpose of this study was to compare the efficacy, safety and cost operative of Radiofrequency Ablation for the Benign thyroid nodules.
Materials and Methods:-
From July 2016 to August 2017, 30 patients with nodular goiter who treated by Radiofrequency Ablation in our hospital.
An internally cooled radiofrequency system and an 18 Gauge internally cooled electrode were used in guidance of Logic E9 Ultrasound system.
We followed up the patients for the duration of 1-3-6-12 months to compare efficacy, safety, and cost-effectiveness during this one year of period.
Results:-
After radiofrequency ablation, the nodule volume decreased significantly for the 12 months follow up. The incidence of complication was much lesser and days of hospitalization was significantly lower than surgery and cost-effective.
Conclusion:-
Radiofrequency Ablation is an effective treatment for thyroid nodule.
The advantage of radiofrequency ablation includes fewer complications, preservation of thyroid functions, and few hospitalization days.
Therefore, radiofrequency ablation should be considered the first line of treatment for thyroid nodules.
KEYWORDS
Radiofrequency, LA, MWA, thermal ablation therapies, thyroid nodules, ultrasound.
Introduction:-
The incident of thyroid nodules increasing in recent years.
Current guidelines suggest that thyroid nodules without clinical symptoms can be treated with watchful waiting. However, some patients require treatment because of clinical symptoms or cosmetics problems.
Therefore, minimal invasive treatments for thyroid nodules such as, Ethanol Ablation, Laser Ablation, Microwave Ablation and Radiofrequency Ablation are safe, effective treatment for thyroid nodules.
Ethanol Ablation is used in cystic nodules but not in solid nodules. Laser Ablation, Microwave Ablation and Radiofrequency Ablation are useful in different size of thyroid nodules.
Radiofrequency Ablation is widely used in treatment of benign thyroid nodules, goiter and recurrent thyroid nodules.
Although our research based on small number of patients, but it seems radiofrequency Ablation is safe and effective treatment for thyroid nodules.
Materials and Methods:-
Patients:-
The retrospective study approved by affiliated hospital of Medical University (CHINA) and informed written consent was taken from all the patients before Radiofrequency Ablation procedure. From July 2016 to August 2017, 30 patients with multiple thyroid nodules who were treated with Radiofrequency Ablation under the guidance of Ultrasonography.
All the enrolled patients were fulfilled the following criteria according to Radiofrequency Ablation recommendation.
Devices and Procedures:-
We used a High Vision Priers System (Hitachi Ultrasound System) with a linear probe to diagnose the thyroid nodules and during the Ablation process we used Logic E9 ultrasound system for radiofrequency guidance.
Internally cooled radiofrequency system with an 18 gauge internally cooled antenna with guidance of Logic E9 ultrasound system.
Ultrasound examination revealed the location, size of vascularity of nodules to plan the further procedure of radiofrequency ablation.
Pre-operative, 100 mg strong analgesic injected intramuscular to the patient.
Intraoperative, a mixture of 0.9% normal saline 15 ml with 5ml lidocaine was injected at the side of the thyroid nodule to form an isolation with guidance of Ultrasonography around the 18 gauge internally cooled antenna. The radiofrequency antenna inserted in the nodules one by one with power of 35-40W to get proper ablation of the thyroid nodule with multiple points.
The procedure was finished when the entire thyroid nodule changed into no enhancement zone by real time Ultrasonography with contrast.
The patient underwent an Ultrasonography follow up at the period of 1-3-6-12 months.
18 gauge semi-automatic biopsy needles took thyroid nodule tissue for histological examination.
Post-operative Ultrasonography shows no enhancement of thyroid nodules after radiofrequency ablation.
Post-operative, 10 mg of dexamethasone was injected to the local area to reduce local edema after radiofrequency ablation.
The procedure was smooth, and the patient did not complain about any obvious discomfort.
Result:-
According to our research of radiofrequency ablation, we found that the radiofrequency ablation is a safe and effective treatment for thyroid nodules.
Significant decrease in volume of thyroid nodules seen at the time of follow up at 1-3-6-12 months of periods with adequate function of thyroid nodules.
According to data of our patients, there are no significant complications and no obvious discomfort during and after radiofrequency ablation.
Lower the days of hospitalization.
Efficacy:-
Efficacy of thyroid nodule before and after radiofrequency ablation has shown in the above figure and chart which shows radiofrequency ablation technique under guidance of Ultrasonography is very safe and efficient treatment for thyroid nodules.
Discussion:-
Our small population study of radiofrequency ablation under guidance Ultrasonography for treatment of thyroid nodules demonstrated that radiofrequency ablation effectively decreases the volume of thyroid nodule and recurrence rate of thyroid nodule is almost similar with open surgery. The complication rate was significantly very lower, in addition function of thyroid gland gradually gets normal after radiofrequency ablation and the cost of radiofrequency ablation is very reasonable with lower days of hospitalization and clinical recovery of patient is faster and easier without need of any hospitalization and there is no external scar on the area of radiofrequency ablation.
Conclusion:-
According to our study, we found that radiofrequency ablation is first line treatment for thyroid nodule because it has less complication and no cosmetic scars and no residual nodules after ablation and there is no effect on thyroid function.
Lower recurrence rate after radiofrequency ablation and less hospitalization days after all the procedure. Hence, radiofrequency ablation can be considered as first line treatment for thyroid nodules according to our study.
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