García Cristhian, Solis-Pazmino Paola, Pilatuna Eduardo, Perez Ana, Figueroa Luis A
Institute of Thyroid and Head and Neck Diseases (ITECC), Quito, Ecuador.
Head and Neck Surgery Department, Surgery Group of Los Angeles, Los Angeles, CA, USA.
Gland Surg. 2024 Mar 27;13(3):426-432. doi: 10.21037/gs-23-425. Epub 2024 Mar 22.
Treating hyperthyroidism induced by autonomously functioning thyroid nodules (AFTNs) through radioactive iodine and surgery often results in undesirable hypothyroidism. Radiofrequency ablation (RFA) has arisen as a favorable option. European guidelines recommend RFA for small AFTN in young patients, aiming to restore normal thyroid function and avoid irradiation. The procedure, costing between 500 and 1,000 euros, is conducted in outpatient clinics and takes 15 to 40 minutes. We aimed to describe the clinical outcomes of AFTN patients treated with RFA in Ecuador.
We included eight patients with toxic thyroid nodules suppressed thyroid-stimulating hormone (TSH), with symptomatic hyperthyroidism. The mean age was 41.63 years [standard deviation (SD): 14.97 years]. The median follow-up time was 8 months. Nodules were solid (37.5%) or predominantly solid (62.5%). The mean volume pre-RFA was 5.27 mL [interquartile range (IQR), 0.70-9.66 mL]. After ablation, the median volumes at 1, 3, and 6 months were [2.25 (SD: 1.67; P<0.12), 1.28 (SD: 1.1; P=0.013), and 1.37 (SD: 1; P=0.23) mL], respectively. The volume reduction (VR) was 45.8%, 75.1%, and 69.7% at 1-, 3-, and 6-month follow-up, respectively.
RFA holds promise as a potential therapeutic approach for managing AFTNs. The success and the feasibility of RFA in this series are consistent with other studies as a treatment option in young patients with small AFTN. However, more research is needed to establish comprehensive guidelines and protocols to maximize the benefits of RFA in AFTNs.
通过放射性碘和手术治疗自主功能性甲状腺结节（AFTN）引起的甲状腺功能亢进症，常常会导致不良的甲状腺功能减退。射频消融（RFA）已成为一种不错的选择。欧洲指南推荐对年轻患者的小型AFTN进行RFA，旨在恢复正常甲状腺功能并避免辐射。该手术在门诊进行，费用在500至1000欧元之间，耗时15至40分钟。我们旨在描述在厄瓜多尔接受RFA治疗的AFTN患者的临床结果。
我们纳入了8例甲状腺毒性结节抑制促甲状腺激素（TSH）且有症状性甲状腺功能亢进的患者。平均年龄为41.63岁[标准差（SD）：14.97岁]。中位随访时间为8个月。结节为实性（37.5%）或主要为实性（62.5%）。RFA前的平均体积为5.27 mL[四分位间距（IQR），0.70 - 9.66 mL]。消融后，1、3和6个月时的中位体积分别为[2.25（SD：1.67；P<0.12）、1.28（SD：1.1；P = 0.013）和1.37（SD：1；P = 0.23）mL]。在1、3和6个月随访时，体积缩小（VR）分别为45.8%、75.1%和69.7%。
RFA有望成为治疗AFTN的一种潜在治疗方法。本系列研究中RFA的成功率和可行性与其他研究一致，可作为年轻小型AFTN患者的一种治疗选择。然而，需要更多研究来制定全面的指南和方案，以最大限度地提高RFA治疗AFTN的益处。
