Search

Background: Thermal ablation and conventional thyroidectomy are effective therapeutic methods for treating benign thyroid nodules (BTNs), but the psychological impacts of these methods in BTN patients are largely unknown. Materials and methods: This survey study prospectively enrolled patients who were admitted to our hospital between July 2021 and July 2022. The four validated scales were applied to quantify psychological distress and sleep quality at five points (the day admitted to the hospital, the day discharged from the hospital, and 1, 3, and 6 months after treatment). Participants who were diagnosed with BTNs and completed the questionnaires were ultimately enrolled and divided into thermal ablation and conventional thyroidectomy groups. A propensity score matching (PSM) cohort was subsequently developed to evaluate longitudinal and cross-sectional changes in psychological-related indicators. Results: Among 548 eligible BTN patients, 460 patients completed all the questionnaires throughout the follow-up (response rate: 83.94%), including 368 (80.00%) patients who underwent thermal ablation and 92 (20.00%) patients who underwent conventional thyroidectomy. After PSM, a total of 342 patients were enrolled (256 patients underwent thermal ablation, and 86 patients underwent conventional thyroidectomy). The psychological-related indicators of patients in the thermal ablation group remained relatively stable during the 6-month follow-up, but patients in the conventional thyroidectomy group may have experienced greater anxiety and sleep quality concerns in the longitudinal assessment. Additionally, in the cross-sectional evaluation, the sleep quality of the thermal ablation group was also better than that of the conventional thyroidectomy group postoperatively. Conclusions: Thermal ablation is superior to conventional thyroidectomy for BTN patients in terms of psychological-related indicators. [ABSTRACT FROM AUTHOR]

Background: Papillary thyroid cancer (PTC) is the most frequent endocrine cancer. Aberrant expression of miRNAs can increase the risk of thyroid cancer. We aimed to investigate the miR-126-3p and miR-146a-5p plasma levels in patients with thyroid nodules and to identify their associations with clinicopathological characteristics, and progression of PTC. Methods: We enrolled forty healthy control and forty patients with thyroid nodules; benign thyroid nodules (BTN), (n=30), and PTC(n=10). We analyzed miR-126-3p and miR-146a-5p levels by using real-time PCR. Results: miR-126-3p expression level was downregulated in PTC patients (0.40±0.11) compared with BTN (0.58±0.12) and healthy subjects (0.87±0.31), P<0.001*. Regarding miR-146a-5p, its level was upregulated in PTC patients (4.59±1.61) compared with BTN (3.77±0.96) and healthy subjects (0.99±0.41), Additionally, miR-126-3p and miR-146b-5p levels were significantly associated with tumor progression, lymph node metastasis, TNM staging, and thyroid function tests. The diagnostic power of miR-126-3p in the prediction of PTC, the AUC was 0.860 with a sensitivity of 60 % and specificity of 87.3% at cutoff values =0.49. miR-146a-5p level in the prediction of PTC, the AUC was 0.742 with a sensitivity of 80 % and specificity of 74.3% at cutoff values =3.4. Conclusions: miR-146a-5p and miR-126-3p levels were dysregulated in patients with PTC compared to patients with BTN and the control group. The dysregulated miRNAs were associated with clinicopathological features of PTC. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of ultrasound (US)-guided radiofrequency ablation (RFA) and conventional open thyroidectomy (OT) in the treatment of benign thyroid nodules (BTN). Methods: Medical records of 103 patients with BTN undergoing surgical treatment at The Affiliated Jiangning Hospital of Nanjing Medical University from March 2019 to March 2022 were retrospectively analyzed. Records show that 53 patients underwent US-guided RFA (observation group) and 50 patients underwent conventional OT (control group). Perioperative indicators (operation duration, intraoperative blood loss, postoperative hospital stay, incision length, and VAS score 12h and 24h after surgery), complications, thyroid function, and nodule recurrence in both groups were compared and analyzed. Results: Perioperative indicators of patients in the observation group were better, and the visual analogue scale (VAS) scores at 12 and 24 hours after the surgery were lower than those of the control group (p<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). There was no statistically significant difference in the preoperative levels of thyroid-stimulating hormone (TSH), serum free thyroxine (FT4) and serum free triiodothyronine (FT3) between the two groups (p>0.05). The postoperative TSH levels in the observation group increased compared to the preoperative levels and were higher than those in the control group, while FT4 and FT3 levels decreased after surgery and were lower than those in the control group (p<0.05). Conclusions: Compared to conventional open thyroidectomy, US-guided RFA is associated with less trauma, faster recovery, fewer complications, and less impact on thyroid function in the treatment of patients with BTN. [ABSTRACT FROM AUTHOR]

Thyroid nodules are a common occurrence in the Indian population. The current management involving an individualized approach is increasingly becoming relevant instead of a broad diagnostic and management algorithm. The consensus statements derived in this article aim to provide a summary of the current medical evidence for the diagnosis and management of thyroid nodules, which assists in optimizing recommendations in the Indian setting. The task force of experts has provided inputs to address specific clinical questions in this consensus. The statements are formulated after a thorough analysis of several published studies and guidelines to address the screening, diagnosis, and management of thyroid nodules. A well-defined grading system is used to appraise the evidence and grade the strength of recommendations. This guideline covers risk stratification of thyroid nodules (differentiating benign from malignant lesions) and a guide to the use of fine-needle aspiration cytology to improve definitive management. The guideline covers evidence-based recommendations for the management of benign, cytologically indeterminate, and malignant thyroid nodules. The panel has also touched upon the aspects of nondiagnostic thyroid nodule management and intraoperative neuromonitoring. These evidence-based expert consensus statements can provide useful and practical insights to aid the practicing clinician. [ABSTRACT FROM AUTHOR]

To explore the safety, clinical efficacies and outcomes of ultrasoundguided percutaneous microwave ablation for children with benign thyroid nodules. Methods A retrospective analysis was conducted for the clinical data of 9 children with benign thyroid nodules undergoing ultrasoundguided percutaneous microwave ablation from January 2022 to December 2022. The relevant parameters included general surgical profiles (incision size, total operative duration, ablation duration, intraoperative volume of blood loss & necessity for blood transfusion), pain scores, thyroid function and ultrasoundrelated parameters. Results In 9/ 14 nodules, overall operative duration was (45.11±4.85) (2365) min, ablation time (188.89±50.37) (40 500) sec and intraoperative volume of hemorrhage (0.3±0.03) (0.10.4) mL. The postoperative WongBaker pain rating scale (FACES) scores were (24)/(02) points at 12/24 h. Immediate postoperative contrastenhanced ultrasonography confirmed the ablation rate of all 14 nodules was 100%. The median nodule volume was 0.73 (0.14,3.62) cm³ before operation, 0.54 (0.15,1.49) cm³ at 1 month after opeation, 0.03 (0.02,0.25) cm³ at 4 months after operation, The nodule volume at 4 months after operation was significantly smaller than that before operation (H = 12. 174, P=0.018) and 1 month after operation (H= 12. 036, P = 0.028) The serum FT3 was (6.44±1.42) .44±1.42) (4.43 (4.438.2) Pmol/L preoperation, (12.8±3.37) (8.36 18.5) Pmol/L at 12 h postoperation, (7.54±1.56) (5.369.53) Pmol/L at Month 1 postoperation. Serum FT3 was significantly higher at 12 h postoperation than preoperation (F=19.636, P<0.001). No statistically significant differences existed in serum levels of FT4 and TSH at various timepoints (P>0.05). Neither adverse reactions nor postoperative complications occurred. Conclusions Ultrasoundguided percutaneous microwave ablation is ideal benign thyroid nodules in children. It offers such advantages as miniinvasiveness, high safety, satisfactory outcomes, minimal damage to thyroid function and minimal pains. However, the study's limited sample size necessitates further largescale trials for validating the findings. [ABSTRACT FROM AUTHOR]

Background: A new minimally invasive technique, ultrasound-guided thermal ablation has become one of the treatment methods for benign thyroid nodules. This study aims to evaluate the efficacy and safety of laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA) in the treatment of elderly patients with benign thyroid nodules. Methods: PubMed, Web of Science, and Cochrane Library were searched for qualified randomized controlled studies (RCTs) issued from establishing databases to March 2022. After screening and evaluating the article quality, the data on nodular volume reduction rate (VRR) and the incidence of complications after thermal ablation were extracted and analyzed by RevMan 5.3 and Stata l4.0. Results: The meta-analysis included seven articles with 3055 participants. We found that LA, RFA, and MWA could markedly reduce the volume of benign thyroid nodules. LA was superior to RFA and MWA in reducing the volume of benign thyroid nodules in 6 months of follow-up (all P

Thyroid nodules (TNs) are pathological changes characterized by abnormal proliferation of thyroid gland tissue. Approximately 19% to 67% of asymptomatic individuals are diagnosed with TNs, with the majority being benign nodules and 4% to 6.5% being thyroid cancer nodules. Western medicine recommends regular examinations and surgery, while traditional Chinese medicine (TCM) provides an alternative choice to maintain thyroid function and reduce the need for surgery. However, in Taiwan, research on TCM treatment for benign TNs is primarily limited to case reports, lacking large-scale and systematic clinical studies. We conducted a search of electronic databases including PubMed, Google Scholar, Wanfang Data, and China National Knowledge Infrastructure to collect clinical trials related to TCM treatment for TNs. Our goal is to provide new treatment options, further validate the value of TCM in the treatment of TNs, and lay a foundation for future clinical research.

Introduction: Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA). AIMS: This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique." Materials and methods: From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6 months. Results: Before treatment, the mean major diameter was 38.4 ± 10.0 mm, and the mean volume was 13.6 ± 10.5 mL. At 1 month, the mean volume was 6.8 ± 6.2 mL, and at 3 months, it was 4.6 ± 4.1 mL. The mean Volume Reduction Rate (VRR) at 3 months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1–20, and ≥ 20.1 mL, respectively. For these nodules, the mean VRR at 3 and 6 months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively. Conclusion: Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance. [ABSTRACT FROM AUTHOR]

Objective: To compare the effect of contrast-enhanced ultrasound (CEUS) and conventional ultrasound-guided radiofrequency ablation (RFA) on benign thyroid nodules (BTNs). Methods: In this retrospective observational study, the data of 72 patients with BTNs who received RFA treatment in The Fourth Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to December 2021 were retrospectively reviewed and selected. The records showed that 34 patients received RFA under the guidance of conventional ultrasound (conventional ultrasound group) and 38 patients received RFA under the guidance of CEUS (CEUS group). The effect of treatment, complications and recurrence of the two groups were compared and analyzed. Results: There was a smaller volume of thyroid nodules in the two groups immediately post-operation. The incidence of complications was lower in the CEUS group (5.26%) compared to the conventional ultrasound group (23.53%) (P<0.05). The recurrence rate at 6-months (0.00% vs 11.76%) and 12- months (2.63% vs 20.59%) post-operation was lower in the CEUS group compared to the conventional ultrasound group (P<0.05). Conclusions: Compared with conventional ultrasound, CEUS-guided RFA is effective in treating BTNs, with smaller postoperative nodule volume, reduced occurrence of surgical complications, and reduced recurrence rate of thyroid nodules. [ABSTRACT FROM AUTHOR]

Background: Prevalence of thyroid nodules is high in the adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need to be treated. In the last two decades, minimally-invasive treatments of the thyroid (MITT) have been proposed in routine clinical practice as a reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs). Aim of the study: To perform a cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs. Methods: Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian tertiary Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs. Results: In the study lapse, 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs; median age: 57 yrs). Before MITT, the mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA when using one optic fiber; 1761.43 € for LTA when using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct—i.e., preoperative, operative and postoperative—costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285,377.15 € has been obtained treating the 148 patients by MITT instead of surgery. Likewise, MITT was advantageous also for indirect costs—i.e., those related to "loss of productivity" caused by time off work due to hospital stay and recovery time—, for both the self-employed workers and the Government, the latter saving 53,838.50 € overall. Finally, intangible costs, related to patients' quality of life—e.g., residual surgical scar, stress related to general anesthesia, convalescence, and life-long intake of L-Thyroxine replacement therapy—were all in favor of MITT. Conclusions: This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285,377.15 € for direct costs to those of 53.838,50 € for indirect costs, in total 339,215.65 € were saved. The saving concern patients, the National Health System and the Government. [ABSTRACT FROM AUTHOR]

Purpose Thermal ablation (TA) is a minimally invasive treatment method for symptomatic benign thyroid nodules (BTNs). This study aimed to evaluate the value of TA by comparing the efficacy, safety, and patient satisfaction with conventional/open thyroidectomy (ConT) and endoscopic thyroidectomy (ET) for symptomatic BTNs. Methods Patients with symptomatic BTNs who underwent ConT, ET, or TA therapy between January 2018 and January 2020 were included. Pre-operation data of the two comparisons (TA vs. ConT and TA vs. ET) was balanced using propensity score matching. The technique efficacy (volume reduction ratio ≥50%), nodule disappearance, and regrowth rate were calculated after ablation. The operation and hospitalization time, medical cost, complications, post-operative symptoms, and cosmetic scores were recorded and compared. Patient satisfaction was evaluated using a telephone survey. Results After a median 19-month follow-up (range, 12–36 months), the technique efficacy rate, nodule disappearance, and regrowth rate were 93.2% (119/129), 6.8% (10/129), and 0.8% (1/129), respectively. Operation time, hospitalization time, and medical costs were less for patients in the TA group than for patients in the ConT and ET groups (all p 0.05). Post-operative hypothyroidism was less frequent in the TA group than in the ConT and ET groups (all p

Introduction Radiofrequency ablation (RFA) is recognized as an effective technique for the treatment of benign thyroid nodules (BTNs), although the long-term results are limited. This study aimed to evaluate the residual vital volume increase, regrowth, and new growth over a 2-year period after RFA among different nodule volume groups.Subjects and Methods This retrospective study evaluated 135 patients with 153 BTNs who underwent ultrasound guided RFA. The BTNs were categorized into small (30 mL) according to the initial volume of BTNs prior to ablation. The volume changes of each nodule were analyzed at 1, 3, 6, 12 and 24 months after RFA. New growth was defined as the growth in volume not found in the early follow-up on ultrasonography.Results The initial ablation ratio of all BTNs was 99.67%. The mean volume reduction ratio (VRR) of BTNs was 85.53% after 2-year follow-up. The small nodule group showed a lower VRR compared to the other two groups at the 1-month follow-up, and there was no difference of VRR at the subsequent follow-ups. The incidence of residual vital volume increase was 4.58%. The overall incidence of regrowth was 3.92% and the mean timing of regrowth was 16.71 months. New growth occurred in 18.95% of patients. No further treatment was required in the majority of cases.Conclusion RFA achieved a clinically relevant volume reduction in different sizes of single BTNs which persisted for at least 2 years, thereby preventing the need for retreatment.

Background: Image-guided thermal ablation interventions are novel thermal-based modalities used for the treatment of benign thyroid nodules. Methods: We conducted a systematic review and a Bayesian network meta-analysis, examining studies using thermal ablation interventions in the treatment of benign nodular thyroid disease (PROSPERO CRD42022367680). The primary endpoints included volume reduction rate (VRR), and symptomatic score and cosmetic score improvement. Secondary endpoints included vocal disturbances, laryngeal nerve palsy, hypothyroidism, and nodular regrowth (defined by increased nodular volume of >50% for thermal ablation or new nodules arising in remaining thyroid tissue conventional surgery [CS]). Results: We included 16 studies (3 randomized controlled trials [RCTs] and 13 comparative case series), describing radiofrequency ablation (RFA), laser ablation (LA), microwave ablation (MWA), high-intensity focus ultrasound (HIFU), and CS, respectively. The review included data from 4112 patients followed for a mean of 11.9 months. Meta-analyses showed no significant differences among RFA, LA, MWA, HIFU, and CS regarding any of the primary endpoints of VRR, symptomatic score, and cosmetic score. In examining the surface under the cumulative ranking area (SUCRA) ranking, CS (SUCRA, 98.49), LA (SUCRA, 51.58), and MWA (SUCRA, 57.0) were identified as the three interventions that were most likely to result in the largest VRR, symptomatic and cosmetic score reduction. RFA, relative risk (RR) 0.19 [95% credibility interval (CI): 0.06 to 0.48], LA RR 0.23 [CI: 0.06 to 0.79], and MWA RR 0.25 [CI: 0.09 to 0.60] were associated with the greatest reduction in risk for postintervention vocal complications compared with CS, with RFA (SUCRA, 61.62) being ranked as the highest in safety. RFA RR 0.05 [CI: 0.00 to 0.40] and MWA RR 0.16 [CI: 0.02 to 0.73] were associated with a reduced risk of transient laryngeal nerve injury compared with CS. RFA RR 0.00 [CI: 0.00 to 0.00] and MWA RR 0.00 [CI: 0.00 to 0.03] were associated with a reduced risk of hypothyroidism occurrence compared with CS, with RFA (SUCRA, 99.86) yielding the highest safety ranking. RFA was associated with a reduced risk for nodular regrowth RR 0.09 [CI: 0.00 to 0.85], compared with CS. Conclusion: We have comprehensively reviewed the published literature on the efficacy and safety of thermal ablation modalities for benign thyroid nodules. Important research gaps remain regarding a paucity of both long-term data and high-quality RCTs. [ABSTRACT FROM AUTHOR]

Context: The natural history of benign thyroid nodules is typically characterized by slow growth and minimal risk of malignant transformation. Available data have, to date, been unable to elucidate the diversity of benign nodule growth patterns over time nor predictive of which patients follow which pattern. Objective: We aimed to better define the diverse patterns of benign nodule behavior and their predictors. Methods: We prospectively studied 389 consecutive patients with solitary, solid, cytologically benign thyroid nodules ≥1 cm and follow-up ultrasound for at least 4 years. Demographic, sonographic, biochemical data were collected at initial evaluation, and subsequent growth patterns were identified over the follow-up. Predictors of growth at initial evaluation and 3 years of follow-up were defined. Results: The mean (±SD) follow-up was 7.7 (±2.7) years. Three distinct growth patterns were identified: A) stagnant nodules with average growth rate<0.2 mm/year; B) slow-growing nodules with a rate 0.2 to 1.0 mm/year; and C) fast-growing nodules increasing>1.0 mm/year. Fast-growing nodules represented 17.2% of the cohort, and were more frequent in patients younger than 50 years (OR 2.2 [1.2-4.1], P=0.016), and in larger nodules (2.0-2.9 cm, OR 3.5 [1.7-7.1], P=0.001;>3.0 cm, OR 4.4 [1.8-10.4], P=0.001 vs reference 1-1.9 cm). In a multiple regression model, nodule growth at 3 years at an average growth rate over 0.2 mm/year over 3 years since initial evaluation was an independent predictor of longer-term fast nodule growth, even after adjusting for age, biological sex, TSH level, and nodule size (P<0.001). Conclusion: The natural history of benign nodule growth is diverse, with over 80% of nodules demonstrating minimal to no growth long-term. Nearly 20% of cytologically benign nodules may exhibit a fast, continued growth pattern, which can be predicted by the 3-year growth rate pattern. These findings can help inform decision making for tailored benign nodule follow-up and monitoring. [ABSTRACT FROM AUTHOR]

Background: For cytologically benign thyroid nodules with very low to intermediate suspicion ultrasound patterns, optimal ultrasound follow-up intervals and outcomes of discontinuing follow-up are unclear. Methods: Ovid MEDLINE, Embase, and Cochrane Central were searched through August 2022 for studies comparing different ultrasound follow-up intervals and discontinuation versus continuation of ultrasound follow-up. The population was patients with cytologically benign thyroid nodules and very low to intermediate suspicion ultrasound patterns, and the primary outcome was missed thyroid cancers. Utilizing a scoping approach, we also included studies that were not restricted to very low to intermediate suspicion ultrasound patterns or evaluated additional outcomes such as thyroid cancer-related mortality rate, nodule growth, and subsequent procedures. Quality assessment was performed, and evidence was synthesized qualitatively. Results: One retrospective cohort study (n = 1254; 1819 nodules) compared different first follow-up ultrasound intervals for cytologically benign thyroid nodules. There was no difference between >4- versus 1- to 2-year intervals to first follow-up ultrasound in the likelihood of malignancy (0.4% [1/223] vs. 0.3% [2/715]), and no cancer-related deaths occurred. Follow-up ultrasound at >4 years was associated with increased likelihood of ≥50% nodule growth (35.0% [78/223] vs. 15.1% [108/715]), repeat fine needle aspiration (19.3% [43/223] vs. 5.6% [40/715]), and thyroidectomy (4.0% [9/223] vs. 0.8% [6/715]). The study did not describe ultrasound patterns or control for confounders, and analyses were based on interval to first follow-up ultrasound only. Other methodological limitations were not controlling for variability in follow-up duration and unclear attrition. The certainty of evidence was very low. No study compared discontinuation of ultrasound follow-up versus continuation. Conclusions: This scoping review found that evidence comparing different ultrasound follow-up intervals in patients with benign thyroid nodules is limited to one observational study, but suggests that the subsequent development of thyroid malignancies is very uncommon regardless of follow-up interval. Longer follow-up may be associated with more repeat biopsies and thyroidectomies, which could be related to more interval nodule growth that meets thresholds for further evaluation. Research is needed to clarify optimal ultrasound follow-up intervals for low to intermediate suspicion cytologically benign thyroid nodules and outcomes of discontinuing ultrasound follow-up for very low suspicion nodules. [ABSTRACT FROM AUTHOR]

Purpose To investigate the effects of microwave ablation (MWA) on visible benign thyroid nodules (BTN) with different internal characteristics. Materials & methods A total of 51 cases with 53 visible BTN were treated by ultrasound-guided percutaneous MWA. The 53 nodules were classified into three categories according to the internal characteristics, which were simple solid, mainly solid and mainly cystic nodules. Ultrasound examinations were performed to evaluate the volume shrinkage rations during follow-up. The thyroid functions and the cervical cosmetic scores were evaluated. The complications were observed during and after ablation. Results A total of 53 symptomatic BTN were treated by MWA completely. The average volume of the nodules was 11.68 ± 10.16 ml, the volume reduction rates (VRR) at 1st, 3rd, 6th, 12th, and 18th months after ablation were 0.29 ± 0.27, 0.46 ± 0.25, 0.67 ± 0.19, 0.83 ± 0.10, and 0.92 ± 0.10, respectively. The VRR was significantly different among the three categories of lesions (p

BackgroundIn recent years, papillary thyroid carcinoma is considered to be one of the fastest increaseing cancer. NDRG family member 3 (NDRG3) has been proposed as a molecular marker of tumor, and is expected to be used in clinic.MethodsEnzyme-linked immunosorbent assay was used to detect the serum NDRG3 expression in 81 papillary thyroid carcinoma cases, 75 benign thyroid nodules cases and 77 healthy control cases, respectively. Electrochemiluminescence method was applied to measure the levels of triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody. Immunohistochemical staining was used to detect the expression of NDRG3 in papillary thyroid carcinoma, benign thyroid nodules and normal tissues adjacent to cancer.ResultsThe expression of serum triiodothyronine, tetraiodothyronine, thyrotropin, thyroglobulin antibody and thyroid peroxidase antibody and NDRG3 were significantly different among benign thyroid nodules, papillary thyroid carcinoma cases and healthy control groups (P

Background: Nodular thyroid disease is very common in clinical practice, discovered by palpation in 3 to 7% and by ultrasound (US) in about 50% of the general population. The aim of this work to compare and evaluate the indications, efficacy, morbidity and post-operative complications of Image Guided Ablation in comparison to thyroid Surgeries Methods: This study involved a systematic review with a metaanalysis conducted on English-language retrospective or prospective studies available on PubMed from the past 5 years. Focused on patients aged 18 years or older who had undergone either thyroid surgery or image-guided thyroid ablation. Patients were categorized into two distinct groups: Group A undergone thyroid surgery, and Group B, undergone imageguided thyroid ablation Results: There was a significant difference regarding age and nodule volume of the two groups. with insignificant difference regarding sex and nodule parameter. Incidence of hoarseness and postoperative pain were significantly lower in the thermal ablation (TA) group than in the conventional thyroidectomy group. No heterogeneity with hoarseness while a significant heterogeneity was in postoperative pain. Incidence of hypothyroidism was not significantly lower in the TA group than in the conventional thyroidectomy group with a significant heterogeneity. In terms of symptom improvement, the difference was insignificant with low heterogeneity. TA yielded significantly better postoperative cosmetic effects than conventional thyroidectomy with no heterogeneity, also associated with a shorter hospitalization time with a significant high heterogeneity Conclusions: TA may be a favorable alternative to thyroidectomy, offering comparable outcomes with reduced morbidity and improved cosmetic satisfaction. [ABSTRACT FROM AUTHOR]

Thyroid nodules, also known as goiter in Traditional Chinese Medicine (TCM), is a common disease affecting the endocrine system. This paper reviewed the clinical data of a patient with benign thyroid nodules of Qi stagnation and phlegm obstruction type. Related nursing measures were summarized form the perspectives of Traditional Chinese Medicine syndrome differentiation, efficacy of Traditional Chinese medicine prescription, key acupoints and routine nursing intervention. Based on the TCM theory, acupoint application is effective and safe in clinical symptoms relief of the patient with benign thyroid nodules of Qi stagnation and phlegm obstruction type. (甲状腺结节属于中医“瘿病”范畴, 是内分泌系统常见疾病。本文回顾1例穴位贴敷治疗气郁痰阻型甲状腺良性结节患者的护理体会, 本文从中医辨证、穴位贴敷药方功效、穴位作用、常规护理等方面进行了总结。基于中医理论指导, 运用穴位贴敷治疗甲状腺良性结节临床效果良好, 无明显不良反应, 值得临床参考借鉴。)

Background: Radiofrequency ablation (RFA) has been widely applied in patients with benign thyroid nodules (BTNs), and complete ablation in a single-session treatment brings great benefits to patients. While how the ablation should be planned and performed to achieve complete ablation in a single-session treatment in large BTNs remains unknown. Purpose: To determine a more suitable ablation strategy for sufficient treatment in a single-session treatment. Materials and methods: This retrospective study included 108 BTNs receiving RFA treatment. These patients were divided into two groups: group A using one insertion point with a fan-shaped overlapping mode and group B using multiple insertion points with a novel parallel overlapping mode. All the treatments used a hydrodissection approach and moving-shot technique. Contrast-enhanced ultrasonography (CEUS) was used to guide the supplementary ablation. Follow-ups were performed at 1, 3, 6 and 12 months. The rates of supplementary ablation, initial ablation ratio (IAR), the rates of complete ablation (CAR), treatment effects and complications between the two groups were compared. Results: The group B had larger treated nodules (10.2ml vs 6.4ml, P<0.001) than group A, while group B had a lower rate of supplementary ablation (21.6% vs 75.4%, P<0.001), especially in the BTNs with craniocaudal diameters ≥30mm (22.0% vs 100%, P<0.001). With the assistance of supplementary ablation, both groups achieved similar IAR (100% vs 100%, P=0.372) and CAR (94.7% vs 94.1%, P=1.000). Two groups showed similar VRRs at 12-month follow-up (77.9% vs 77.5%, P=0.894) and similar rates of complications (3.5% vs 2.0%, P=1.000). Conclusions: Needle placement using the multiple insertion points with a novel parallel overlapping mode would be easier to achieve complete ablation with less supplementary ablation, especially in large nodules. [ABSTRACT FROM AUTHOR]

Background: Thyroid nodule is a common clinical finding and may be associated with a 5%–7% risk for malignancy. Methods for the detection of malignancy had their own drawbacks, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) may give a promising result to solve this dilemma. The Aim of the Study: This study aims to evaluate NLR and PLR as predictors of malignancy in solitary thyroid nodules. Also, to estimate their effect on tumor size, lymph node metastasis, and extrathyroidal extension. Patient and Methods: Prospective cohort study conducted at Major Teaching Hospital over a period of 1 year. Patients with solitary thyroid nodules were included in the study and according to histopathological results divided into two groups (A: Malignant and B: Benign), blood samples were drawn from participants, and measurement of lymphocyte, neutrophil, platelet, NLR, and PLR was done. Results: Both NLR and PLR were higher in cases of malignancy with a cutoff point for NLR >2.9 associated with 84.8% sensitivity (SN) and 71.4% specificity (SP), while PLR >140.15 associated with 87.9% SN and 71.4% SP. High NLR is further associated with larger tumor size. Conclusion: Both NLR and PLR are good predictors of malignancy of thyroid nodules. NLR of more than 2.9 is associated with larger-size tumors. [ABSTRACT FROM AUTHOR]

Purpose: The study evaluated high-intensity-focused ultrasound (HIFU) for benign thyroid nodules in terms of efficiency, complication rate, influence of preablative nodule size, parameters influencing the therapeutic success and hormonal-thyroid-function. Methods: Seventy-two patients with 75 nodules were treated with HIFU at 2 centers from 2014–2019. Median nodule volume was 4.4 ml (range 0.33–53). The therapeutic ultrasound probe (EchoPulse THC900888-H) generated 80–90 °C in the target tissue with 87.6–320.3 J per sonication. Nodal volume was measured at baseline and over 12 months after therapy in a retrospective bicentric-study with long-term follow-up. Hormonal-thyroid function (TSH, T3, T4) was measured before and after ablation. Complications were assessed. Results: Significant volume reduction (p < 0.05 Wilcoxon-signed-rank test) of thyroid nodules was 38.98% at 3 months, 37.32% at 6 months, 61.54% at 9 months and 60.66% at 12 months. Volume reduction of nodules <3 ml did not differ significantly from nodules >3 ml (p > 0.05 Mann–Whitney test). At 3 months solid nodules had a significant volume reduction of 52.08%, complex nodules of 32.57%, nodules treated under regional anesthesia of 33.07% and under general anesthesia of 49.47%. Hormonal-thyroid function was not influenced significantly by HIFU therapy (p > 0.05 Wilcoxon-signed-rank test). Complication rate was 3.8%. No long-term complications occurred. Conclusion: Significant volume reduction of thyroid nodules up to 12 months after HIFU was shown. All complications were reversible. Therapy was more efficient in solid than complex nodules and in nodules treated under general anesthesia than with regional anesthesia. Hormonal-thyroid-function was not affected. Trial registraftion number: 2020-1728-evBO. Date of registration: 16.06.2020. Agency: Ethik-Kommission bei der Landesäztekammer Hessen [ABSTRACT FROM AUTHOR]

Rationale and Objectives: To evaluate the efficacy of microwave ablation (MWA) for benign thyroid nodules (BTNs) and compare trauma and complication rates between MWA and traditional thyroidectomy for BTNs.Materials and Methods: 84 patients with BTNs were recruited and followed up at 1, 3, 6, and 12months. 56 and 28 patients chose to undergo MWA (group A) and traditional thyroidectomy (group B), respectively. Efficacy was assessed by volume reduction rate (VRR) and therapeutic success rate (TSR) at each follow-up. Trauma was compared using inflammation response parameters, visual analog scale (VAS) scores, quality of life (QOL) and thyroid function measures at 1, 3, and 6 months. Complications rates were also compared.Results: The VRR was 80.70 ± 18.60%, and TSR was 91.70% at 6-months. Furthermore, the VRR increased to 90.45 ± 11.51%, and TSR increased to 100% at 12-months. C-reactive protein levels were significantly higher in group B on the first postoperative day (POD) (3.89 ± 0.86 mg/mL vs 3.39 ± 0.56 mg/mL, p = 0.002). Visual analog scale scores were significantly lower in group A on the first and second POD. Thyroid stimulating hormone levels were significantly lower in group A at three (1.71 ± 1.12uIU/mL vs 2.37 ± 1.24uIU/mL, p = 0.013) and 6-months (1.34 ± 0.70uIU/mL vs 1.97 ± 0.94uIU/mL, p = 0.002). There were no significant between-group differences in QOL and complication rates.Conclusion: Microwave ablation shows acceptable and promising efficacy. Compared with thyroidectomy, MWA was associated with less trauma and comparable complication rates. [ABSTRACT FROM AUTHOR]

Purpose Thermal ablation is a novel treatment alternative for benign thyroid nodules, and one of the most promising thermal ablation techniques is radiofrequency ablation (RFA). Considering the increasing use of thyroid RFA, some scientific societies have proposed clinical practice guidelines. We systemically reviewed and compared these guidelines for thyroid RFA to identify a standard treatment strategy that represents the positions of most societies. Methods We searched the MEDLINE and EMBASE databases for studies with human participants that were published in English between January 1, 2000 and August 2, 2019. Studies containing clinical practice guidelines for the RFA of benign thyroid nodules were included. We extracted data regarding indications, pre- and post-procedural evaluations, treatment techniques, and the need to obtain informed consent. Results Of the 83 studies found, four studies were included, and one study was added after searching the bibliographies of those articles. The five included studies were guidelines developed by the Korean Society of Thyroid Radiology, a group of experts from Italian scientific societies, the Italian Working Group on Minimally Invasive Treatments of the Thyroid, the United Kingdom’s National Institute for Health and Clinical Excellence, and a group of four professional Austrian thyroid associations. Indications, pre- and post-procedural evaluations, and techniques were similar across studies; however, differences in each of these categories were found. Conclusion While the reviewed guidelines are similar with regard to major categories, international guidelines for the RFA of benign thyroid nodules should be established in the future.

Abstract Background We evaluated 45 benign thyroid nodules of 40 patients treated with radiofrequency (RF) ablation and followed up for 6 months. The inclusion criteria included unilateral or bilateral thyroid nodules with compression symptoms or cosmetic problems, cytological confirmation of benignity without atypical cells, and patient refusal or unfit for surgery. There was no predilection for the size, number, ultrasound nature of the nodules, (solid, cystic, or complex). RF ablation was performed using Mygen (M-3004) RF generator from RF Medical Co., Ltd, South Korea. The volume of the nodules and clinical problems were evaluated before and after the procedure. Complications and factors related to volume reduction were evaluated. The purpose of the study is to evaluate the efficacy and safety of US-guided radiofrequency (RF) ablation in the treatment of benign thyroid nodules. Results The volume reduction ratio (%) of the thyroid nodules was statistically significant. The mean VRR was 58.41 ± 15.27SD at 1 month, 73.26 ± 11.22SD at 3 months, and 82.54 ± 12.49SD at 6 months. P value was < 0.001. The radiofrequency ablation did not affect the normal thyroid function of the 38 patients who were euthyroid at the start of the study. Thyroid function normalized 1 month after ablation of the two autonomously functioning thyroid nodules. The compressive symptoms resolved in 22 patients (55%) and improved in the rest of the 18 patients (45%) with the median decreased from 8 (IQR 6–9), range 4–10 before treatment to 0 (IQR 0–1), range 0–3 after 6 months. Cosmetic problems improved in all 40 patients by P value < 0.001. The procedure had no sustained or life-threatening complications. Conclusions RF ablation was effective in reducing the size of the benign thyroid nodules and in controlling nodule-related compressive symptoms as well as cosmetic problems. There were no major complications sustained and no life-threatening complications or sequelae happened. RF ablation can be used as an alternative non-surgical minimally invasive treatment for patients with benign thyroid nodules.

Objectives To explore the efficacy of microwave ablation (MWA) in the treatment of benign thyroid nodules, and analyze related influencing factors. Methods The clinical and ultrasound data of 115 patients with 115 benign thyroid nodules treated with MWA were retrospectively analyzed. The volume of nodules at 1, 3, 6, and 12 months after the procedure was obtained, and the volume reduction rate (VRR) at each time point was calculated. With VRR > 90% as the criterion for nodule cure, binary logistic regression was employed to screen the factors that affect the efficacy. Results ① At 1, 3, 6, and 12 months after the procedure, the volume of nodules continued to decrease, the VRR gradually increased, and the differences at each time point were statistically significant (p

Background. Over the last 15 years, there have been many recommendations for the management of patients with thyroid nodules, based on the assessment of various ultrasound (US) criteria in B-mode. In 2020, the EU-TIRADS system (2017) was included in Russian Clinical Practice Guidelines. Shear wave elastography (SWE) increases the diagnostic efficacy of ultrasonic B-mode examination of thyroid nodules and can be recommended to be included in the current classification system. Objective. The study aims to assess the diagnostic efficacy of multiparametric US combining SWE and color flow mapping in differentiating between benign and malignant thyroid nodules to define their stage according to the EU-TIRADS system and decide on the need for fine-needle aspiration biopsy. Material and Methods. A total of 150 thyroid nodules from 116 patients were analyzed. Lesions were then classified according to the EU-TIRADS system, SWE with an assessment of the color map and tissue stiffness was performed (Emean). In all tumors, cytological and histological (in operated patients) verification was carried out. Results. After B-mode US with color flow mapping, differentiation of palpable thyroid abnormalities by the EU-TIRADS system was carried out. 78 nodules were classified as EU-TIRADS 2 (52%), 42 as EU-TIRADS 3 (28%), 26 as EU-TIRADS 4 (17.3%), 4 as EU-TIRADS 5 (2.7%). On cytological examination 42 tumor nodules were detected. Of these, 6 (14.3%) cases were reported as papillary thyroid carcinoma, 36 (85.7%) as follicular neoplasm, 22 (61%) among the last prove to be follicular carcinoma. Qualitative and quantitative evaluation of elastograms was performed. Benign nodules were colored primarily in blue, while suspicious for malignancy revealed red areas of different size. Elasticity index in benign nodules was 24.3 ± 5.63 kPa for colloid goiter, 27.8 ± 6.35 kPa for cellular goiter; in suspicious for malignancy this index was 80.9 ± 50.9 kPa for follicular neoplasm, 114 ± 56.8 kPa for papillary thyroid cancer. The stiffness cutoff value for malignancy indicated with ROC-analysis was estimated as 45.4 kPa. Mean elasticity index (kPa) was significantly higher in suspicious for malignancy nodules than in benign nodules (р < 0.05). Of 120 (80%) nodules, primarily assessed as benign and defined as EU-TIRADS 2 and 3, 18 (12%) nodules after SWE revealed areas of high stiffness exceeding the cutoff value. After that, these nodules were transferred to EU-TIRADS 4 and 5, and these stages require fine-needle aspiration. Of these, 11 (7.3%) cases were reported as follicular neoplasm, 6 (4%) among the last prove to be follicular thyroid carcinoma. Conclusion. Using multiparametric approach with SWE will give the opportunity to classify correctly the nodule according to the EU-TIRADS and to identify greater number of thyroid tumors for fine-needle aspiration. SWE made it possible to increase the specificity of US using the EU-TIRADS system. The characteristics of the SWE score were: sensitivity = 81%, specificity = 90.3%, positive predictive value = 88%, negative predictive value = 91%, and accuracy of comprehensive study = 88.4%.

To investigate the effects of microwave ablation (MWA) on visible benign thyroid nodules (BTN) with different internal characteristics. A total of 51 cases with 53 visible BTN were treated by ultrasound-guided percutaneous MWA. The 53 nodules were classified into three categories according to the internal characteristics, which were simple solid, mainly solid and mainly cystic nodules. Ultrasound examinations were performed to evaluate the volume shrinkage rations during follow-up. The thyroid functions and the cervical cosmetic scores were evaluated. The complications were observed during and after ablation. A total of 53 symptomatic BTN were treated by MWA completely. The average volume of the nodules was 11.68 ± 10.16 ml, the volume reduction rates (VRR) at 1st, 3rd, 6th, 12th, and 18th months after ablation were 0.29 ± 0.27, 0.46 ± 0.25, 0.67 ± 0.19, 0.83 ± 0.10, and 0.92 ± 0.10, respectively. The VRR was significantly different among the three categories of lesions (p < 0.05). The symptoms of all patients were improved. Thyroid function indicators were fluctuated in normal range. There were no serious complications during and after the procedure. MWA of visible BTN is safe and effective, and the short-time ablation effect is significantly different due to the internal characteristics of the nodule. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to evaluate the usefulness of CT for quantitative assessment of the neck structures after RFA in patients with benign thyroid nodules. Materials and methods This single-center, retrospective cohort study included 38 patients with benign thyroid nodules who had received RFA and had available pre- and post-treatment CT images. Changes in the tracheal anteroposterior (AP)/transverse diameter ratio, cross-sectional tracheal area, midline deviation of the trachea, and anterior neck angle after RFA were quantitatively measured using CT. Volume reduction rates (VRRs) for the thyroid gland and nodules were measured using CT and US, respectively, and the intraclass correlation coefficient (ICC) was calculated. The paired Wilcoxon signed-rank test was used to compare pre- and post-treatment CT-based measurements, and univariate linear regression analysis was performed to determine the association of VRR with the mean delivered radiofrequency energy, number of RFA sessions, and initial thyroid volume. Results After RFA, the tracheal AP/transverse diameter ratio and midline deviation were significantly decreased while the tracheal area and anterior neck angle were significantly increased (all, p

Background Image-guided radiofrequency ablation (RFA) of large solid benign thyroid nodules (BTNs) usually require a high amount of energy. Injection of ethanol into a benign thyroid nodule before RFA can lower the procedural time and patient discomfort. Objective To investigate the efficacy and safety of ethanol ablation (EA) combined with RFA in the treatment of solid BTNs (>10 ml) and to compare this modified method with RFA treatment alone. Methods A total of 366 nodules in 366 patients were treated from June 2017 to Mar. 2018, 76 (M:F = 32:44, age 46 ± 14 years) were treated with EA + RFA and 290 (M:F = 99:191, age 49 ± 14 years) were treated with RFA. 44 patients (44 nodules) of each group formed a matched cohort after adjustment with propensity score matching. The average time, energy and power of the RFA procedure were retrospectively compared between the two groups. The postoperative nodule volume reduction ratio (VRR), compressive symptoms, cosmetic concerns, comprehensive satisfaction score, thyroid function and complications were retrospectively compared within and between the two groups after 6 months after treatment. Results No significant differences were observed in the baseline characteristics between groups after propensity score matching adjustment. The mean RFA time (454.7 s (interquartile range (IQR), 290.8–589.0 s vs. 796.0 s (IQR, 554.0–976.30 s), p 30 ml, p = .456), respectively. The Medium nodules shrunk more than the large nodules (all p

Abstract Background Benign thyroid nodules (BTN) are frequently diagnosed as papillary thyroid carcinoma (PTC), leading to unnecessary treatment. We found that plasma lncRNA DLG1-AS1 was upregulated in PTC patients but not in BTN patients and healthy controls. Methods In this study DLG1-AS1 and miR-199a-3p in plasma of both PTC patients and BTN patients were detected by qPCR. ROC curve analysis was performed for diagnostic analysis. Overexpression experiments were performed to analyze the interaction between DLG1-AS1 and miR-199a-3p. CCK-8 assay was performed to analyze cell proliferation. Results In this study, upregulation of DLG1-AS1 distinguished PTC patients from BTN patients and healthy controls. Plasma miR-199a-3p was downregulated in PTC patients compared with healthy controls and BTN patients. Plasma levels of miR-199a-3p were inversely correlated in PTC patients, but not in BTN patients and healthy controls. miR-199a-3p overexpression failed to significantly affect DLG1-AS1, while DLG1-AS1 overexpression resulted in downregulated miR-199a-3p, In addition, DLG1-AS1 overexpression promoted the proliferation of PTC cells. miR-199a-3p overexpression played an opposite role and attenuated the effects of DLG1-AS1 overexpression. Conclusions Therefore, DLG1-AS1 may promote PTC by downregulating miR-199a-3p.

Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.

Background: Elastosonography is a promising non-invasive technique that developed in recent years for evaluating thyroid nodules. It assesses nodule stiffness or displacement depending on the applied force to differentiate malignant from benign thyroid nodules. Objectives: The aim of this study was to evaluate the diagnostic utility of real time US elastography in the differentiation the benign from malignant thyroid nodule. Patients and methods: A cross-sectional was carried out on 40 patients attending ultrasound unit/radiology in Al-Imamein Al-Kadhimein Medical city in Baghdad/Iraq from September 2018 to August 2019. All patients were examined by B-mode ultrasound, color Doppler, and real-time elastography by Voluson-E6 Ultrasound machine. Final diagnoses obtained from histological and/or cytological evaluation. Results: The mean age of 40 patients was 43.7±11.7 years with the range of 25-70 years. 28 (70%) of them were female and 12 (30%) were male. Of the 40 lesions 34 (85%) were benign and 6 (15%) were malignant lesions. Malignant thyroid nodules were significantly hypoechoic, with irregular margin, taller than wider, showed microcalcification and exhibited a significant increase in vascularity with varying rate of sensitivity and specificity. Orientation (taller than wider) was the most ultrasound predictive pattern of malignancy with sensitivity, specificity, and accuracy of 66.7%, 100%, and 92.5% respectively. The mean strain ratio of all nodules was 2.7±2.1 ranged 0.4-13.5 with significant result. The optimal strain ratio cutoff value was >2.5 and showed to have a sensitivity of 100%, specificity 88.2%, positive predictive value 67%, negative predictive value 100%, and accuracy rate 90%. Conclusion: Elastosonography can assist in the differential diagnosis of malignant and benign thyroid nodules, as strain elastosonography improve the diagnostic performance in differentiating the benign and malignant thyroid nodule. strain ratio is higher in malignant than benign nodules. [ABSTRACT FROM AUTHOR]

Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer. [ABSTRACT FROM AUTHOR]

PurposeTo confirm the efficacy of ultrasound (US) guided radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, we evaluated as primary outcome the technical efficacy and clinical success in a single center dataset. The secondary outcome was to find a correlation between nodules’ pre-treatment features and volume reduction rate (VRR) ≥75% at 12 months after RFA and during follow-up period.MethodsThis retrospective study included 119 consecutive patients (99 females, 20 males, 51.5 ± 14.4 years) with benign thyroid nodules treated in our hospital between October 2014 and December 2018 with a mean follow-up of 26.8 months (range 3–48). Clinical and US features before and after RFA were evaluated by a US examination at 1, 3, 6, 12 months and annually thereafter up to 48 months.ResultsThe median pre-treatment volume was 22.4 ml; after RFA we observed a statistically significant volume reduction from the first month (11.7 ml) to the last follow-up (p < 0.001 for all follow-up times). The median VRR was 47.1, 55.3, 61.2, 67.6, 72.8, 71.3, and 62.9% at 1, 3, 6, 12, 24, 36, and 48 months of follow-up respectively, showing a progressive significant improvement up to 24 months (VRRs 1 vs 3 months, 3 vs 6 months and 6 vs 12 months p < 0.001, 12 vs 24 months p = 0.05) while no differences at 24 vs 36 and 36 vs 48 months were observed. Symptoms improved significantly (complete resolution 64.35%, partial resolution 35.65%), and neck circumference was reduced as compared to pre-treatment (p < 0.001). Lower pre-treatment neck circumference (37.5 vs 36.0 cm, p = 0.01) was a positive predictor of VRR ≥75% at 12 months. Macrocystic echostructure (HR 2.48, p 0.046) and pre-treatment volume >22.4 ml (HR 0.54, p 0.036) were found to be independent positive and negative predictors of VRR ≥75% respectively. One-month post RFA VRR ≥50% represented the best positive predictor of technical success.ConclusionsThis study confirmed the efficacy of RFA in the treatment of benign thyroid nodules. In particular we show that by selecting macrocystic nodules smaller than 22.4 ml better long-term response can be achieved, which is predicted by an early shrinkage of the nodule.

Purpose: To confirm the efficacy of ultrasound (US) guided radiofrequency ablation (RFA) in the treatment of benign thyroid nodules, we evaluated as primary outcome the technical efficacy and clinical success in a single center dataset. The secondary outcome was to find a correlation between nodules' pre-treatment features and volume reduction rate (VRR) ≥75% at 12 months after RFA and during follow-up period. Methods: This retrospective study included 119 consecutive patients (99 females, 20 males, 51.5 ± 14.4 years) with benign thyroid nodules treated in our hospital between October 2014 and December 2018 with a mean follow-up of 26.8 months (range 3–48). Clinical and US features before and after RFA were evaluated by a US examination at 1, 3, 6, 12 months and annually thereafter up to 48 months. Results: The median pre-treatment volume was 22.4 ml; after RFA we observed a statistically significant volume reduction from the first month (11.7 ml) to the last follow-up (p < 0.001 for all follow-up times). The median VRR was 47.1, 55.3, 61.2, 67.6, 72.8, 71.3, and 62.9% at 1, 3, 6, 12, 24, 36, and 48 months of follow-up respectively, showing a progressive significant improvement up to 24 months (VRRs 1 vs 3 months, 3 vs 6 months and 6 vs 12 months p < 0.001, 12 vs 24 months p = 0.05) while no differences at 24 vs 36 and 36 vs 48 months were observed. Symptoms improved significantly (complete resolution 64.35%, partial resolution 35.65%), and neck circumference was reduced as compared to pre-treatment (p < 0.001). Lower pre-treatment neck circumference (37.5 vs 36.0 cm, p = 0.01) was a positive predictor of VRR ≥75% at 12 months. Macrocystic echostructure (HR 2.48, p 0.046) and pre-treatment volume >22.4 ml (HR 0.54, p 0.036) were found to be independent positive and negative predictors of VRR ≥75% respectively. One-month post RFA VRR ≥50% represented the best positive predictor of technical success. Conclusions: This study confirmed the efficacy of RFA in the treatment of benign thyroid nodules. In particular we show that by selecting macrocystic nodules smaller than 22.4 ml better long-term response can be achieved, which is predicted by an early shrinkage of the nodule. [ABSTRACT FROM AUTHOR]

In this paper, the application value of the enhancement feature and quantitative parameters of contrast-enhanced ultrasound in the identification for papillary thyroid carcinoma and benign nodules were explored, as well as their relationship whit biological behaviors of the thyroid carcinoma. There were 68 patients with papillary thyroid carcinoma who were seeded as the study group, and 65 patients WILL benign thyroid nodules who were seeded as the control group. The contrast enhancement features of the study group were manly low enhancement in the early stage or in the whole stage, and in the control group was manly equal or high enhancement. There was a statistically significant difference in enhancement characteristics of contrast enhanced ultrasound between the two groups (P$0. 05). The PI of the study group was lower than that of the control group, and the TTP was longer than the control group (P$0. 05). The area under the curve (AUC) of the combined diagnosis for thyroid micro papillary carcinoma by contrast enhanced ultrasound, PI, and TTP was 0. 896, which was greater than that of each index alone. Tumor diameter, extragiandular mvasoon and lymph node metastasis of thyroid micropapiliary carcinoma were negatively correlated with the enhanced degree of contrast-enhanced ultrasound and PI, and positively correlated WITH TTP. The degree of differentiation was positively correlated with the enhanced degree of contrast-enhanced ultrasound and PI, and negatively correlated with TTP (P<0. 05). In conclusion, contrast-enhanced ultrasound features and quantitative parameters (PI and TTP) have high diagnostic efficiency in the diagnosis of thyroid micropapillary carcinoma, and has a close correction whit the biological behavior of cancer. [ABSTRACT FROM AUTHOR]

Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.

Due to the increasing rates of physical examination and application of advanced ultrasound machines, incidences of benign thyroid nodules (BTNs) and papillary thyroid microcarcinoma (PTMC) were dramatically up-regulated in recent years. Thermal ablation (TA) has been widely used and regarded as a safe and effective method to eliminate or reduce BTNs and recurrent low-risk PTMC. However, conclusions using TA to treat primary PTMC are controversial. Recently, several long-term and prospective studies on TA treatment of BTNs and primary PTMC have been reported. Here, we review current literatures and progress on TA treatment of BTNs and PTMC and underline the way to get the best treatment outcomes, providing a comprehensive insight into the research progresses in this field.

Aim: To compare the effects of the liquid-isolating maneuver and the lever-elevating maneuver in protecting cervical structures during microwave ablation for treating high-risk benign thyroid nodules. Methods: This prospectively study was approved by the Medical Ethics Committee of Panzhihua Central Hospital. A total of 174 patients were enrolled and randomly assigned to a liquid-isolating maneuver group (LIM, n = 87) or a lever-elevating maneuver group (LEM, n = 87). Operation time, postoperative voice change, time to recovery of baseline voice, peri-thyroid hematoma, neck tension, and intraoperative vasovagal reaction were assessed. Results: Operation time was greater in the LIM group than in the LEM group (44.75 ± 13.14 vs. 32.87 ± 10.84 min; p = .017).Voice changes were observed in 6 patients in the LIM group and 2 in the LEM group (6.9% vs. 2.3%, p = .278). The time to recovery of baseline voice was significantly greater in the LIM group compared with the LEM group (36.15 ± 10.24 vs. 24.48 ± 11.53 days, p = .014). The incidences of peri-thyroid hematoma and neck tension were higher in the LIM than in the LEM group (11.5% vs. 3.4%, 10.3% vs. 2.3%, p = .044 and p = .029). One patient (1.1%) in the LEM group and none of the patients in the LIM group experienced a vasovagal response (p = 1.000). Conclusion: The lever-elevating method is feasible and effective for the microwave ablation of benign thyroid nodules, with better protection of neck structures than observed with the liquid-isolating method.

Background: We evaluated 45 benign thyroid nodules of 40 patients treated with radiofrequency (RF) ablation and followed up for 6 months. The inclusion criteria included unilateral or bilateral thyroid nodules with compression symptoms or cosmetic problems, cytological confirmation of benignity without atypical cells, and patient refusal or unfit for surgery. There was no predilection for the size, number, ultrasound nature of the nodules, (solid, cystic, or complex). RF ablation was performed using Mygen (M-3004) RF generator from RF Medical Co., Ltd, South Korea. The volume of the nodules and clinical problems were evaluated before and after the procedure. Complications and factors related to volume reduction were evaluated. The purpose of the study is to evaluate the efficacy and safety of US-guided radiofrequency (RF) ablation in the treatment of benign thyroid nodules. Results: The volume reduction ratio (%) of the thyroid nodules was statistically significant. The mean VRR was 58.41 ± 15.27SD at 1 month, 73.26 ± 11.22SD at 3 months, and 82.54 ± 12.49SD at 6 months. P value was < 0.001. The radiofrequency ablation did not affect the normal thyroid function of the 38 patients who were euthyroid at the start of the study. Thyroid function normalized 1 month after ablation of the two autonomously functioning thyroid nodules. The compressive symptoms resolved in 22 patients (55%) and improved in the rest of the 18 patients (45%) with the median decreased from 8 (IQR 6–9), range 4–10 before treatment to 0 (IQR 0–1), range 0–3 after 6 months. Cosmetic problems improved in all 40 patients by P value < 0.001. The procedure had no sustained or life-threatening complications. Conclusions: RF ablation was effective in reducing the size of the benign thyroid nodules and in controlling nodule-related compressive symptoms as well as cosmetic problems. There were no major complications sustained and no life-threatening complications or sequelae happened. RF ablation can be used as an alternative non-surgical minimally invasive treatment for patients with benign thyroid nodules. [ABSTRACT FROM AUTHOR]

Objectives: To explore the efficacy of microwave ablation (MWA) in the treatment of benign thyroid nodules, and analyze related influencing factors. Methods: The clinical and ultrasound data of 115 patients with 115 benign thyroid nodules treated with MWA were retrospectively analyzed. The volume of nodules at 1, 3, 6, and 12 months after the procedure was obtained, and the volume reduction rate (VRR) at each time point was calculated. With VRR > 90% as the criterion for nodule cure, binary logistic regression was employed to screen the factors that affect the efficacy. Results: ‹ At 1, 3, 6, and 12 months after the procedure, the volume of nodules continued to decrease, the VRR gradually increased, and the differences at each time point were statistically significant (p < 0.05). A total of 29 (25.21%) nodules disappeared completely at 12 months after the procedure; › Multivariate stepwise logistic regression showed that there was a statistically significant difference for the internal component of nodules, enhancement mode, and immediate volume after the procedure in determining the ablation efficacy (p < 0.05); fi The ROC curve was plotted for predicting the efficacy of MWA, with the results showing that the AUC, sensitivity, specificity, and accuracy were 0.82, 67.50, 88.00, 79.10%, respectively; fl 11 cases (9.56%) had side effects, 10 cases (8.70%) had minor complications, and three cases (2.61%) had major complications. Conclusion: MWA is safe and effective in the treatment of benign thyroid nodules. The internal component of nodules, enhancement mode, and immediate volume after the procedure are independent factors that affect the efficacy of ablation. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency ablation (RFA) and laser ablation (LA) are effective treatments for benign thyroid nodules. Due to their relatively recent introduction into clinical practice, there are limited long-term follow-up studies. This study aimed to evaluate technique efficacy, rate of regrowth, and retreatment over 5 years after RFA or LA and to identify predictive factors of outcome. Methods: In this multicenter retrospective study, the rates of technique efficacy, regrowth, and retreatment were evaluated in 406 patients treated with either RFA or LA, and followed for 5 years after initial treatment. Propensity score matching was used to compare treatments. Cumulative incidence studies with hazard models were used to describe regrowth and retreatment trends, and to identify prognostic factors. Logistic regression models and receiver operating characteristic analyses were used for risk factors and their cutoffs. Results: RFA and LA significantly reduced benign thyroid nodule volume, and this reduction was generally maintained for 5 years. Technique efficacy (defined as a reduction ≥50% after 1 year from the treatment) was achieved in 74% of patients (85% in the RFA and 63% in the LA group). Regrowth occurred in 28% of patients (20% in the RFA and 38% in the LA group). In the majority of cases, further treatment was not required as only 18% of patients were retreated (12% in the RFA and 24% in the LA group). These data were confirmed by propensity score matching. Cumulative incidence studies showed that RFA was associated with a lower risk of regrowth and a lower risk of requiring retreatment over time. Overall, technique inefficacy and regrowth were associated with low-energy delivery. Retreatments were more frequent in young patients, in large nodules, in patients with lower volume reduction at 1 year, and in cases of low-energy delivery (optimal cutoff was 918 J/mL for RFA). Conclusions: Both thermal ablation techniques result in a clinically significant and long-lasting volume reduction of benign thyroid nodules. The risk of regrowth and needing retreatment was lower after RFA. The need for retreatment was associated with young age, large baseline volume, and treatment with low-energy delivery. [ABSTRACT FROM AUTHOR]

Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium. [ABSTRACT FROM AUTHOR]

Due to the increasing rates of physical examination and application of advanced ultrasound machines, incidences of benign thyroid nodules (BTNs) and papillary thyroid microcarcinoma (PTMC) were dramatically up-regulated in recent years. Thermal ablation (TA) has been widely used and regarded as a safe and effective method to eliminate or reduce BTNs and recurrent low-risk PTMC. However, conclusions using TA to treat primary PTMC are controversial. Recently, several long-term and prospective studies on TA treatment of BTNs and primary PTMC have been reported. Here, we review current literatures and progress on TA treatment of BTNs and PTMC and underline the way to get the best treatment outcomes, providing a comprehensive insight into the research progresses in this field. [ABSTRACT FROM AUTHOR]

To explore the effect of percutaneous microwave ablation and traditional operation on the curative effect, thyroid function and complications of benign thyroid nodule. 102 cases of thyroid benign nodule were treated in our hospital from July 2016 to July 2018. According to different surgical methods, the patients were divided into control group and experimental group, 51 cases in each group. The number of nodules before and after operation, the average volume of nodules, thyroid function [free triiodothyronine (FT3), total thyroxine (TT4), thyrotropin (TSH)] and the reduction rate of postoperative nodules were compared. Results: compared with the control group, the hospitalization time, operation time, intraoperative bleeding volume and postoperative scar length in the experimental group were significantly reduced (P<0.05).Compared with the preoperative group, the number and average volume of nodules in the two groups were significantly reduced (P<0.05); compared with the control group, the number, average volume and reduction rate of nodules in the experimental group were significantly reduced (P<0.05). Compared with 17.65% (9/51) of the control group, the incidence of complications in the experimental group was 3.92 (2/51) (P<0.05). There was no significant difference in TSH, FT3 and TT4 levels between the two groups (P>0.05). Compared with the preoperative level, TSH in the control group was significantly higher, FT3 and TT4 were significantly lower (P<0.05). Compared with the preoperative, the SAS and SDS scores of the two groups were significantly lower (P<0.05). Compared with the control group, the SAS score and SDS score of the experimental group were significantly lower (P<0.05). Compared with the preoperative, the VAS scores of the two groups were significantly lower (P<0.05). Compared with the control group, the VAS score of the experimental group was significantly lower (P<0.05). the effect of percutaneous microwave ablation is better than that of traditional operation. It can effectively protect the thyroid function and reduce the incidence of complications. It has high clinical value and can be further popularized. [ABSTRACT FROM AUTHOR]

The occurrence of thyroid nodules and goiter increases with age. In general, surgery age is a predictor of perioperative morbidity. In thyroid surgery, there are different data on the role of age on morbidity. We investigated the influence of age on the outcome in thyroid surgery in a prospective single cohort study with a follow-up after 1 year.