Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
Department of Radiology, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2018 Aug;93(8):1018-1025. doi: 10.1016/j.mayocp.2017.12.011. Epub 2018 Mar 21.
To assess the effectiveness, tolerability, and complications of radiofrequency ablation (RFA) in patients with benign large thyroid nodules (TNs).
This is a retrospective review of 14 patients with predominantly solid TNs treated with RFA at Mayo Clinic in Rochester, Minnesota, from December 1, 2013, through October 30, 2016. All the patients declined surgery or were poor surgical candidates. The TNs were benign on fine-needle aspiration, enlarging or causing compressive symptoms, and 3 cm or larger in largest diameter. We evaluated TN volume, compressive symptoms, cosmetic concerns, and thyroid function.
Median TN volume reduction induced by RFA was 44.6% (interquartile range [IQR], 42.1%-59.3%), from 24.2 mL (IQR, 17.7-42.5 mL) to 14.4 mL (IQR, 7.1-19.2 mL) (P<.001). Median follow-up was 8.6 months (IQR, 3.9-13.9 months). Maximum results were achieved by 6 months. Radiofrequency ablation did not affect thyroid function. In 1 patient with subclinical hyperthyroidism due to toxic adenoma, thyroid function normalized 4 months after ablation of the toxic nodule. Compressive symptoms resolved in 8 of 12 patients (67%) and improved in the other 4 (33%). Cosmetic concerns improved in all 8 patients. The procedure had no sustained complications.
In this population, RFA of benign large TNs performed similarly to the reports from Europe and Asia. It induces a substantial volume reduction of predominantly solid TNs, improves compressive symptoms and cosmetic concerns, and does not affect normal thyroid function. Radiofrequency ablation has an acceptable safety profile and should be considered as a low-risk alternative to conventional treatment of symptomatic benign TNs.
评估射频消融（RFA）治疗良性大甲状腺结节（TN）的疗效、耐受性和并发症。
这是对明尼苏达州罗切斯特市梅奥诊所 2013 年 12 月 1 日至 2016 年 10 月 30 日期间接受 RFA 治疗的 14 例主要为实性 TN 患者的回顾性分析。所有患者均拒绝手术或不适合手术。细针抽吸活检显示 TN 为良性，体积增大或引起压迫症状，最大直径为 3cm 或更大。我们评估了 TN 体积、压迫症状、美容问题和甲状腺功能。
RFA 诱导的 TN 体积缩小中位数为 44.6%（四分位距[IQR]，42.1%-59.3%），从 24.2ml（IQR，17.7-42.5ml）降至 14.4ml（IQR，7.1-19.2ml）（P<0.001）。中位随访时间为 8.6 个月（IQR，3.9-13.9 个月）。最大效果在 6 个月时达到。RFA 不影响甲状腺功能。在 1 例因毒性腺瘤引起的亚临床甲状腺功能亢进患者中，消融毒性结节后 4 个月甲状腺功能恢复正常。12 例患者中有 8 例（67%）压迫症状缓解，4 例（33%）改善。8 例患者的美容问题均得到改善。该操作无持续并发症。
在该人群中，RFA 治疗良性大 TN 的效果与欧洲和亚洲的报告相似。它可显著缩小主要为实性的 TN 体积，改善压迫症状和美容问题，且不影响正常甲状腺功能。RFA 具有可接受的安全性，应被视为治疗有症状的良性 TN 的低风险替代方法。
