Journal List > J Korean Thyroid Assoc > v.7(2) > 1056552

Shin: Non-surgical, Image-guided Management of Benign Thyroid Nodules

Abstract

Most thyroid nodules are cytologically benign and can be managed nonsurgically. Asymptomatic benign nodules require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for treatment. Until now in clinical practices, nonsurgical image-guided therapy includes percutaneous ethanol injection, radiofrequency ablation, laser ablation, and high intensity focused ultrasound. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Radiofrequency ablation is an effective procedure for obtaining shrinkage and improving symptoms of solid thyroid nodules. Better understanding of image-guided therapy makes physicians personalize the management of benign thyroid nodules according to a cost-benefit analysis.

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Fig. 1.
A 38-year-old female patient with visible protruded thyroid mass underwent ethanol injection. A 3.9 cm sized cystic nodule (20.1 mL in volume) is seen in the right thyroid gland (A; transverse image, B; longitudinal image). This cystic nodule (arrows) was markedly decreased to 1.6 cm (0.47 mL in volume) 8 months after ethanol ablation (C; transverse image, D; longitudinal image). Volume reduction rate was 97.7%. Her symptom and cosmetic problem were improved.
jkta-7-111f1.tif
Fig. 2.
A 3.9 cm sized solid thyroid nodule (9.0 mL in volume) is noted in the left thyroid gland (A; transverse image, B; longitudina image). Echogenic bubbles (arrows) occur from the tip of the electrode during active radiofrequency ablation (C). Hypoechoic change with echogenic portion of entire nodule indicates acceptable ablation (D). At 3 years after ablation, volume reduction rate of nodule (arrows) was 95.6% (E; transverse image, F; longitudinal image).
jkta-7-111f2.tif
Table 1
Treatment results of radiofrequency ablation for benign thyroid nodules
Author (Published year) No. of nodules Nodule type Follow–up (months) VR (%) Mean No. of session
Kim et al. (2006) 30 cold 1–18 64 1
Jeong et al. (2008) 236 cold 1–41 84 1.4 (1–6)
Deandrea et al. (2008) 31 cold + AFTN 6 51 1
Spiezia et al. (2009) 94 cold + AFTN 12–24 79 1.4 (1–3)
Baek et al. (2009) 9 AFTN 6–17 75 2.2 (1–4)
Baek et al. (2009) 15 cold 6–8 80 1
Lee et al. (2010) 27 cold 6–38 97 1.6 (1–4)

AFTN: autonomously functioning thyroid nodule, VR: volume reduction

Data were adapted from Baek et al.27)

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