Resultados de una sesión única de ablación por radiofrecuencia en nódulos tiroideos benignos: Resultados a 6 meses en 24 pacientes / Single-session treatment of benign thyroid nodules with radiofrequency ablation: Results at 6 months in 24 patient

Objetivo: Valorar la eficacia y la seguridad de una sesión única de ablación por radiofrecuencia (ARF) en pacientes con nódulos tiroideos benignos y de predominio sólido. Pacientes y método: Estudio unicéntrico retrospectivo de práctica clínica habitual en el que se incluyeron pacientes con nódulos tiroideos sólidos benignos sometidos a una sesión única de ARF con seguimiento de al menos 6 meses tras procedimiento, indicada como alternativa a la cirugía por presentar clínica local compresiva y/o evidencia de crecimiento nodular. Los pacientes fueron evaluados antes, al mes, 3 meses y 6 meses de la ARF, así como a los 12 meses en aquellos con seguimiento disponible. En cada evaluación se recogieron variables de eficacia (cambio porcentual del volumen nodular, el porcentaje de nódulos con reducción volumétrica mayor del 50% respecto al volumen inicial, la desaparición de los síntomas de compresión y la posibilidad de retirar la medicación antitiroidea en aquellos casos bajo tratamiento) y variables de seguridad, incluyendo complicaciones menores (dolor que precisó de analgesia convencional, hematoma peritiroideo de reabsorción espontánea) y complicaciones mayores (cambios en la voz, daños en el plexo cervical, ruptura nodular, disfunción tiroidea). Resultados: Se describen los resultados en 24 pacientes con seguimiento de hasta 12 meses en 16 de ellos. El volumen nodular medio pasó de 25,4 ± 15,5 ml antes de la ARF a 10,7 ± 9,9 ml a los 6 meses (p < 0,05) y a 9,9 ± 10,4 ml a los 12 meses (en 16 casos evaluados), resultando la reducción porcentual de volumen significativa desde el mes siguiente al procedimiento. A los 6 meses la reducción media alcanzada fue del 57,5 ± 24% y el 65% de los nódulos presentaban una reducción de volumen mayor del 50%. En aquellos nódulos con un volumen inicial mayor de 20ml (n = 13) la reducción porcentual a los 6 meses fue del 50,4 ± 25,8% frente al 65,3 ± 20,1% en los nódulos de menor volumen inicial (n = 11). La sintomatología compresiva desapareció desde el primer mes en los 12 pacientes que la referían. La medicación antitiroidea pautada antes de la ARF en 4 casos pudo ser retirada en 3. En 9 pacientes se registró la presencia de dolor leve transitorio en las primeras 24 h, que respondió a analgésicos convencionales, y en 7 se objetivó un pequeño hematoma peritiroideo de reabsorción espontánea en la ecografía de control a las 24 a 48 h de la ablación. Al mes de la ARF se observó un caso de rotura nodular, que se resolvió de manera espontánea. No se apreciaron cambios en los valores hormonales en los pacientes eutiroideos. Conclusión: Una sesión única de ARF parece un tratamiento eficaz y seguro en pacientes portadores de nódulos tiroideos benignos sólidos y con clínica compresiva y/o evidencia de crecimiento nodular relevante. Al ser un procedimiento ambulatorio que no precisa anestesia general ni incisión cutánea podría convertirse en una alternativa útil a la cirugía en los casos en que esta sea rechazada o se considere de alto riesgo

Objective: To evaluate the efficacy and safety of one single-session of radiofrequency ablation (RFA) performed in thyroid benign and predominantly solid nodules. Patients and method: Unicentric retrospective study in usual clinical setting that included patients with solid and benign thyroid nodules treated with one single session of RFA and with folllow-up of at at least 6 months after the procedure. RFA was performed as an alternative to surgery in cases of pressure symptoms or nodular growth evidence. Patients were evaluated basally and at one, 3 and 6 months after RFA and also at 12 months if the follow-up was available. In each evaluation efficacy variables were recorded (percentual change from basal volume, percentage of nodules reaching a volume reduction above 50% from baseline, patients with disappearance of pressure symptoms and the possibility of antithyroid drug withdrawal) and safety variables were also registered including minor complications (pain needing analgesic drugs, hematoma) and major complications (voice changes, braquial plexus injury, nodule rupture and thyroid dysfunction). Results: Twenty-four patients with a follow-up of at least 6 months after RFA were included, 16 of them with more than 12 months of follow-up. Mean nodule volume changed from 25.4 ± 15.5 ml basally to 10.7 ± 9.9 ml at month 6 (P < .05) and to 9.9 ± 10,4 ml at month 12 in 16 nodules. Six months after RFA mean volumetric reduction was 57.5 ± 24% and 65% of the nodules reached a volume reduction above 50% from baseline. Median percentage of reduction at month 6 was 50.4 ± 25.8% for nodules with a basal volume above 20 ml (n = 13) and 65.3 ± 20.1% for nodules with a lower basal volume (n = 11). Pressure symptoms reported in 12 patients disappeared in all cases. Antithyroid drugs could be stopped in 3 of 4 cases treated before RFA. A mild and transient pain responsive to conventional analgesic drugs was recorded in 9 patients during the 24 h after the procedure and in 7 a small perithyroid and transient hematoma was observed in the 48 following hours. One major complication was described as a nodule rupture that recovered spontaneously. There were no changes in hormonal values in euthyroid cases. Conclusion: A single session of RFA seems to be an effective and safe procedure in patients with solid thyroid nodules with pressure symptoms or relevant growth evidence. As an outpatient and scarless procedure with no need of general anaesthesia it could become an useful alternative to lobectomy when surgery is refused or in patients at high surgical risk

Single-session treatment of benign thyroid nodules with radiofrequency ablation: Results at 6 months in 24 patients. / Resultados de una sesión única de ablación por radiofrecuencia en nódulos tiroideos benignos: Resultados a 6 meses en 24 pacientes.

OBJECTIVE: To evaluate the efficacy and safety of one single-session of radiofrequency ablation (RFA) performed in thyroid benign and predominantly solid nodules. PATIENTS AND METHOD: Unicentric retrospective study in usual clinical setting that included patients with solid and benign thyroid nodules treated with one single session of RFA and with folllow-up of at at least 6 months after the procedure. RFA was performed as an alternative to surgery in cases of pressure symptoms or nodular growth evidence. Patients were evaluated basally and at one, 3 and 6 months after RFA and also at 12 months if the follow-up was available. In each evaluation efficacy variables were recorded (percentual change from basal volume, percentage of nodules reaching a volume reduction above 50% from baseline, patients with disappearance of pressure symptoms and the possibility of antithyroid drug withdrawal) and safety variables were also registered including minor complications (pain needing analgesic drugs, hematoma) and major complications (voice changes, braquial plexus injury, nodule rupture and thyroid dysfunction). RESULTS: Twenty-four patients with a follow-up of at least 6 months after RFA were included, 16 of them with more than 12 months of follow-up. Mean nodule volume changed from 25.4±15.5ml basally to 10.7±9.9ml at month 6 (P<.05) and to 9.9±10,4ml at month 12 in 16 nodules. Six months after RFA mean volumetric reduction was 57.5±24% and 65% of the nodules reached a volume reduction above 50% from baseline. Median percentage of reduction at month 6 was 50.4±25.8% for nodules with a basal volume above 20ml (n=13) and 65.3±20.1% for nodules with a lower basal volume (n=11). Pressure symptoms reported in 12 patients disappeared in all cases. Antithyroid drugs could be stopped in 3 of 4 cases treated before RFA. A mild and transient pain responsive to conventional analgesic drugs was recorded in 9 patients during the 24h after the procedure and in 7 a small perithyroid and transient hematoma was observed in the 48 following hours. One major complication was described as a nodule rupture that recovered spontaneously. There were no changes in hormonal values in euthyroid cases. CONCLUSION: A single session of RFA seems to be an effective and safe procedure in patients with solid thyroid nodules with pressure symptoms or relevant growth evidence. As an outpatient and scarless procedure with no need of general anaesthesia it could become an useful alternative to lobectomy when surgery is refused or in patients at high surgical risk.