Choice in Ablative Therapies for Thyroid Nodules

Many studies have demonstrated the efficacy of RFA for reducing the volume of benign nodules. A meta-analysis by Ha et al showed a pooled volume reduction of 76.1% at 6 months [11]. Long-term studies demonstrated rapid volume reduction at 12 months, a plateau from 12 to 36 months, and further volume reduction after 36 months [12]. A meta-analysis of long-term outcomes reported a pooled volume reduction of 80.3% at 3 years. The overall complication rate was low at 4.6% with 1.3% major complications, including voice change, laryngeal nerve injury, and brachial nerve injury [12]. Generally, RFA is most effective for smaller nodules (volumes less than 10 mL) with larger nodules requiring more than 1 treatment [13]. The most important technical parameter associated with volume reduction is the total energy delivered [14]. Compared with surgery, RFA is associated with fewer complications, better health-related quality of life, and preservation of thyroid function [17, 44, 45]. However, it can take longer to achieve the desired volume reduction. A meta analysis comparing thermal ablation with surgery found no difference in symptom improvement but significantly lower incidence of pain, hoarseness, and hypothyroidism, better cosmetic outcomes, and shorter hospitalization with thermal ablation [46]. In a telephone survey of 126 patients treated with RFA and 84 patient treated with surgery, there was no difference in the overall satisfaction, but more patients were fully satisfied with the resolution of nodule-related symptoms in the surgery group (96% vs 81%) and more patients were fully satisfied with the cosmetic results in the RFA group (92% vs 69%) [15].