Diagn Interv Radiol. 2023 Jul 20;29(4):628-631. doi: 10.4274/dir.2022.221467. Epub 2022 Dec 23.
Diving thyroid nodules are a limitation of radiofrequency ablation because the mediastinal component cannot be adequately identified by ultrasound (US). We aim to describe a new technique, the iceberg technique, to overcome this issue and explain our three-year experience of using this novel method. The iceberg technique consists of a two-stage treatment. First, the ablation of the cervical portion of the nodules (easily visualized during the initial US exam) using trans-isthmic access is performed using the moving-shot technique. After three to six months, there is a volumetric reduction of the treated portion, leading to retraction of the thyroid parenchyma. This brings the mediastinal component to the cervical region, thereby enabling a perfect visualization by US. Then, the second stage of treatment is carried out with complete nodule ablation, and the region that was treated first is looked at a second time. From April 2018 to April 2021, nine patients with nine benign nodules were submitted for the iceberg technique. No complications occurred during the entire follow-up period. The patients displayed normal hormonal levels after the procedures, and there was a significant volume reduction of the nodules until three months post-ablation. The iceberg technique is an effective and safe option for the radiofrequency treatment of diving goiters.
甲状腺结节内消融是射频消融的局限性，因为纵隔成分无法通过超声（US）充分识别。我们旨在描述一种新技术，即冰山技术，以克服这一问题，并解释我们使用这种新方法的三年经验。冰山技术包括两阶段治疗。首先，使用经峡部入路进行结节颈部部分（在初始 US 检查中容易可视化）的消融，使用移动射击技术进行。三到六个月后，治疗部分的体积减小，导致甲状腺实质回缩。这将纵隔成分带到颈部区域，从而使 US 能够完美地可视化。然后，进行第二阶段的治疗，完全消融结节，并再次观察第一阶段治疗的区域。2018 年 4 月至 2021 年 4 月，9 名患有 9 个良性结节的患者接受了冰山技术治疗。在整个随访期间，未发生任何并发症。术后患者的激素水平正常，结节体积在消融后三个月明显减小。冰山技术是治疗潜水性甲状腺肿的射频治疗的有效且安全的选择。
