Summary:
Three case studies highlight the effectiveness of Thyroid RFA in treating various thyroid conditions. These cases include successful volume reduction in a hyperactive nodule, considerations for regrowth following thyroidectomy, and potential treatment for a large asymptomatic goiter in an elderly patient.
Main Points:
- Case Study 1: 50-Year-Old Woman with Bilateral Nodules
- Hyperactive right thyroid nodule treated with RFA.
- Achieved 86% volume reduction without medication.
- Importance of thorough ablation in toxic nodules.
- Case Study 2: 55-Year-Old Woman with Regrowth Following Thyroidectomy
- Large left substernal mass post-thyroidectomy.
- Consideration of RFA but opted for surgery due to previous thyroidectomy and medication.
- Case Study 3: 83-Year-Old Woman with Large Asymptomatic Goiter
- Large benign goiter, diffuse with no discrete ablation target.
- RFA considered to reduce goiter size and improve quality of life.
- Importance of further research for RFA’s efficacy in similar cases.
Since 2002, Thyroid RFA has provided patients with a minimally invasive, non-surgical, lower-cost treatment for thyroid nodules. The procedure has the potential to strike a balance between efficacy and well-being, providing an alternative to surgery that preserves healthy thyroid tissue with minimal scarring. As an in-office procedure, it is cost-effective for both patients and clinicians, with reduced recovery time compared to thyroidectomy.
While prevalent in much of Asia and Europe, the United States has been slower to adopt the RFA procedure for thyroid indications. Even so, trailblazing clinicians have taken steps toward adopting radiofrequency ablation of the thyroid in their practices.
Likewise, comprehensive clinical trials are ongoing. In its 22-year history, many promising case studies have emerged that provide evidence of the procedure’s efficacy, affordability, and practicality. In fact, STARmed’s thyroid RFA technology is featured in over 180 clinical articles, with more to come as the field continues to expand.
Clinicians affiliated with NASIT, the North American Society for Interventional Thyroidology, have presented several case studies on challenging cases in the field, exploring whether RFA is the appropriate treatment for certain unique indications. Continue reading to learn what these leading innovators have learned about the procedure over the past two decades.
Case Study 1: 50-Year-Old Woman with Bilateral Nodules
The first case study is from Dr. Julia Noel, MD, a practicing surgeon and Assistant Professor of Otolaryngology at Stanford Medicine.
The case is regarding a 50-year-old female patient. The patient presented with low TSH, discovered on routine lab work for estrogen. She was otherwise healthy and on no other medications, including thyroid suppression.
Upon ultrasound, it was found that the patient had an intensely active right thyroid nodule. Imaging found an almost identical, primarily cold nodule on the left side.
The patient was not interested in thyroid supplementation or suppression medications. Dr. Noel performed radiofrequency thyroid ablation on the active right nodule utilizing the hydrodissection technique. 12 months after receiving radiofrequency ablation of the thyroid nodule, the patient has seen an 86% volume reduction, with TSH levels at 1.01 without medication.
Dr. Noel emphasizes that the size and location of toxic nodules are factors in the efficiency of the thyroid RFA procedure. Clinicians should be confident that they can ablate the nodule thoroughly, as toxic nodules tend to be hyperactive and vascular. Leaving parts of clonal neoplasms behind can lead to regeneration and recurrence, making a complete extirpation critical.
Ultrasound guidance makes it easier for clinicians to adjust their approach during the radiofrequency thyroid ablation procedure to ensure thorough ablation occurs. An electrode allowing for adjustable ablation helps deliver the correct amount of energy based on real-time observations.
Case Study 2: 55-Year-Old Woman with Regrowth Following Thyroidectomy
This case study is from Dr. James Lim, MD, practicing surgeon and Assistant Professor of Surgical Oncology at Oregon Health & Science University.
Dr. Lim’s patient was a 55-year-old female who presented with a new left neck mass. The patient had cosmetic concerns and pressure symptoms impacting quality of life. She had previously undergone a total thyroidectomy of a benign goiter with no postoperative complications. The patient is on a full replacement dose of levothyroxine.
Ultrasound and CT of the neck found a large left substernal mass measuring approximately 60 MLs. A fine needle aspiration biopsy found benign thyroid tissue.
The patient had hesitations about a second surgery due to concerns about vocal cord damage and voice changes. Dr. Lim wondered if thyroid RFA was a potential treatment option for this patient, considering her history. He considered offering this patient a staged approach to the treatment of substernal nodules using Thyroid RFA.
However, it was ultimately decided that, as the patient had already undergone thyroidectomy, had a scar, and was taking lifetime medication, there was no benefit to choosing thyroid ablation over surgery in this instance.
Case Study 3: 83-Year-Old Female Retired MD with a Large Asymptomatic Goiter and Low TSH
This case study was presented by Dr. Steven Hodak, MD, Professor of Medicine and Endocrinology at NYU Langone Health.
The patient was an 83-year-old female who presented with a large, repeatedly benign goiter with no discrete lesions. Dr. Hodak suspected a coalescence of bland nodules. A transverse CT found that the right lobe measured 11.3 x 4.7 x 5.2 cm, and the left lobe measured 8.7 x 3.1 x 4.8 cm. During monitoring, the goiter continues to grow.
TSH varied from low-normal to suppressed. However, the goiter was diffuse, meaning there was no discrete target for ablation.
Dr. Hodak wondered if RFA could be used to “cyto-reduce” the thyroid and normalize thyroid function. Furthermore, he questioned if rising TSH levels might become a trophic signal and cause marginal regrowth.
As this is an older patient, Dr. Hodak determined that using RFA to shrink the goiter and restore thyroid function could improve the patient’s quality of life for 10 to 20 years. He would treat this in multiple sessions, with the goal of size reduction vs obliteration.
If he were to proceed with this treatment plan, he would use an RFA electrode with a 1.5cm active tip with high energy to kill and diffuse tissue in the central portions of the nodule. He emphasizes that a large, active tip with control allows for the precise delivery of energy, with attention paid to thermal spillover.
Ultimately, more research is necessary to determine if thyroid RFA would be safe and effective in this or similar indications. However, in many cases, it remains a viable treatment option for older patients for whom surgery is not a safe option.
The future of Thyroid RFA technology begins with you. STARmed America offers training, continuing education, and resources for clinicians interested in adopting this procedure. Contact us to discuss how we can support you in improving the quality of life for your patients.
