Dueñas Juan Pablo, Buitrago-Gómez Nathalia, Rahal Antonio, Steck Jose Higinio, García Cristhian, De Cicco Rafael, Rangel Leonardo G, Voogd Ana, Savluk Lorena, Volpi Erivelto Martinho
Division of Endocrine Surgery, Department of Surgery, Integral Endocrine Surgery Clinic, Medellin, Colombia.
Department of Endocrinology, Universidad Pontificia Bolivariana, Medellín, Colombia.
Thyroid. 2025 Mar;35(3):283-290. doi: 10.1089/thy.2024.0338. Epub 2024 Dec 19.
Autonomously functioning thyroid nodules (AFTNs) represent ∼5% of all thyroid nodules and often necessitate definitive treatments such as surgery or radioiodine (I), both of which have inherent risks. Radiofrequency ablation (RFA) has emerged as an effective and safe therapeutic option for managing AFTNs. This study aims to assess the effectiveness and safety of RFA for solitary AFTNs in various countries across Latin America. This retrospective, observational, multicenter cohort study included patients with a solitary AFTN that was histologically confirmed as benign and treated with a single session of RFA. The study included an analysis of patient demographics, sonographic characteristics of the nodules, thyroid profile assessment at each follow-up visit, evaluation of clinical symptoms to determine the achievement of a euthyroid state, and the measurement of nodule volume reduction. In addition, a bivariate analysis was conducted to identify associations between these variables and the resolution of hyperthyroidism. Our study enrolled 81 patients with a solitary, benign AFTN. The volume reduction ratio (VRR) consistently increased over the follow-up period, with medians of -50%, -74.9%, -78.4%, and -90.2% at 1, 3, 6, and 12 months, respectively. The rate of resolution of hyperthyroidism was 93.8% (76/81). Following the RFA procedure, 58.02% of patients (47/81) normalized their thyrotropin levels within 1 month of follow-up, and by 3 months, an additional 33.3% had achieved normalization (27/81). Notably, a baseline volume ≥10, 20, or 30 mL did not affect the achievement of clinical success. In bivariate analyses, a VRR ≥50% at the 6-month follow-up was associated with the resolution of hyperthyroidism. Overall complications occurred in 6.2% of patients (5/81), including 1.2% (1/81) of a major complication (transient Horner syndrome), 3.7% cases of transient dysphonia (3/81), and 1.2% (1/81) of hypothyroidism requiring low-dose levothyroxine replacement. The results of this multicenter study suggest that RFA is a promising treatment option for patients with solitary AFTN, regardless of their baseline characteristics, including volume, age, or composition. The clinical success of the intervention may be related to the VRR at 6 months.
自主功能性甲状腺结节（AFTNs）约占所有甲状腺结节的5%，通常需要进行手术或放射性碘（I）等确定性治疗，而这两种治疗都有其固有风险。射频消融（RFA）已成为治疗AFTNs的一种有效且安全的治疗选择。本研究旨在评估RFA在拉丁美洲各国治疗孤立性AFTNs的有效性和安全性。这项回顾性、观察性、多中心队列研究纳入了组织学确诊为良性的孤立性AFTN且接受单次RFA治疗的患者。该研究包括对患者人口统计学特征、结节的超声特征、每次随访时的甲状腺功能评估、对临床症状的评估以确定甲状腺功能正常状态的达成情况以及结节体积缩小的测量。此外，还进行了双变量分析以确定这些变量与甲亢缓解之间的关联。我们的研究纳入了81例患有孤立性、良性AFTN的患者。在随访期间，体积缩小率（VRR）持续增加，在1、3、6和12个月时的中位数分别为-50%、-74.9%、-78.4%和-90.2%。甲亢缓解率为93.8%（76/81）。在RFA治疗后，58.02%的患者（47/81）在随访1个月内促甲状腺激素水平恢复正常，到3个月时，又有33.3%的患者（27/81）实现了正常化。值得注意的是，基线体积≥10、20或30 mL并不影响临床成功的达成。在双变量分析中，6个月随访时VRR≥50%与甲亢缓解相关。总体并发症发生在6.2%的患者（5/81）中，包括1.2%（1/81）的严重并发症（短暂性霍纳综合征）、3.7%的短暂性声音嘶哑病例（3/81）以及1.2%（1/81）需要低剂量左甲状腺素替代治疗的甲状腺功能减退。这项多中心研究的结果表明，对于孤立性AFTN患者，无论其基线特征如何，包括体积、年龄或成分，RFA都是一种有前景的治疗选择。干预的临床成功可能与6个月时的VRR有关。
