Elsevier

Endocrine Practice

Volume 21, Issue 8, August 2015, Pages 887-896
Endocrine Practice

Original Articles
Health-Related Quality of Life After Percutaneous Radiofrequency Ablation of Cold, Solid, Benign Thyroid Nodules: A 2-Year Follow-Up Study in 40 Patients

https://doi.org/10.4158/EP15676.ORGet rights and content

ABSTRACT

Objective: We studied the impact of radiofrequency ablation (RFA) on health-related quality of life (HRQL) in patients with benign thyroid nodules (TN) in a 2-year follow-up.

Methods: Forty patients (35 women and 5 men; age, 54.9 ± 14.3 years) with cold thyroid solitary nodules or a dominant nodule within a normofunctioning multi-nodular goiter (volume range, 6.5 to 90.0 mL) underwent RFA of thyroid nodular tissue under ultrasound real-time assistance.

Results: Data are mean and standard deviation. Energy delivered was 37,154 ± 18,092 joules, with an output power of 37.4 ± 8.8 watts. Two years after RFA, nodule volume decreased from 30.0 ± 18.2 mL to 7.9 ± 9.8 mL (-80.1 ± 16.1% of initial volume; P<.0001). Thyroid-stimulating hormone, free triiodothyronine, and free thyroxine levels remained stable. Symptom score measured on a 0- to 10-cm visual analogue scale (VAS) declined from 5.6 ± 3.1 cm to 1.9 ± 1.3 cm (P<.0001). Cosmetic score (VAS 0–10 cm) declined from 5.7 ± 3.2 cm to 1.9 ± 1.5 cm (P<.0001). Two patients became anti-thyroglobulin antibody–positive. Physical Component Summary (PCS)-12 improved from 50.4 ± 8.9 to 54.5 ± 5.3, and the Mental Component Summary (MCS)-12 improved from 36.0 ± 13.3 to 50.3 ± 6.3 (P<.0001 for both score changes).

Conclusion: Our 2-year follow-up study confirms that RFA of benign TNs is effective in reducing nodular volume and compressive and cosmetic symptoms, without causing thyroid dysfunction or life-threatening complications. Our data indicate that the achievement of these secondary endpoints is associated with HRQL improvement, measured both as PCS and MCS.

Abbreviations: fT3 = free triiodothyronine fT4 = free thyroxine HRQL = health-related quality of life MCS-12 = Mental Component Summary-12 PLA = percutaneous laser ablation PCS-12 = Physical Component Summary-12 RF = radiofrequency RFA = radiofrequency ablation SF-12 = Short-Form 12 Health Survey TgAb = anti-thyroglobulin antibody TN = thyroid nodule TRAb = anti-TSH-receptor antibody TSH = thyroid-stimulating hormone US = ultrasound VAS = visual analogue scale

Section snippets

INTRODUCTION

In 2010, the American Association of Clinical Endocrinologists, the Associazione Medici Endocrinologi, and the European Thyroid Association published medical guidelines for the diagnosis and management of thyroid nodules (TNs) (1). Those guidelines suggested the use of ultrasound (US)-guided percutaneous laser ablation (PLA) for the treatment of solid TNs causing symptoms or cosmetic issues in patients who decline surgery or are at surgical risk. In regards to radiofrequency (RF) ablation

Patients

The study design was retrospective and was approved by the Ethical Committee of the Clinical Cancer Research Institute, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. Files for 225 patients consecutively treated with RFA between January 2012 and February 2014 at our institution were reviewed. Patients were referred to our Endocrinology Unit by their physicians for the RFA procedure with compressive symptoms: pressure symptoms, throat constraint, and/or swallowing difficulty (n = 43,

RESULTS

All patients underwent a single RFA treatment. Total energy delivered was 37,154 ± 18,092 joules (median, 34,832 joules; range 5,439 to 82,006 joules), and output power was 37.4 ± 8.8 watts (median, 35 watts; range, 20 to 65 watts). RF delivery time was 22.1 ± 10.9 minutes (median, 20.5 minutes; range, 8.2 to 60.0 minutes). There was a correlation between initial nodule volume and total energy administered (rs = 0.698; P<.0001). Nodule volume changes, PCS-12, MCS-12, symptom score, cosmetic score,

DISCUSSION

This is the first study evaluating HRQL modification after RFA for symptomatic solid TNs. The limitation of this study is the retrospective, noncontrolled design. Our study shows that RFA improves HRQL in patients with symptomatic TNs. Moreover, in agreement with other studies, both the self-reported pressure symptoms and the cosmetic complaints improved after RFA. In our experience, RFA was effective in reducing benign TNs by 80% after 2 years. Our data support that a large area of nodular

CONCLUSION

In conclusion, our study confirms that RF ablation of benign TNs is effective in controlling pressure and cosmetic problems and in reducing nodular volume over a 2-year follow-up, without thyroid dysfunction or life-threatening complications. Our data indicate that the achievement of these secondary endpoints is associated with HRQL improvement, measured both by PCS and MCS. Hence, RFA may be considered a valid option for the clinical management of benign TNs.

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    DISCLOSURE

    The authors have no multiplicity of interest to disclose.

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