Aljammal Jules, Jasim Sina, Alahdab Fares, Rowley Ann, Ferenczi Andrea, Schmeltz Lowell, Andrade Agustin, Ahmad Shahzad
The Thyroid Clinic Utah, Salt Lake City, UT 84124, USA.
Division of Endocrinology, Metabolism and Lipid Research, Washington University in St. Louis, School of Medicine, St Louis, MO 63110, USA.
J Endocr Soc. 2025 May 3;9(7):bvaf077. doi: 10.1210/jendso/bvaf077. eCollection 2025 Jul.
Given the growing utilization of radiofrequency ablation in the management of benign thyroid nodules, the identification of factors predicting successful outcomes is increasingly relevant for optimizing patient selection.
This study is looking for potential factors influencing volume reduction (VR) after RFA in benign thyroid nodules.
This is a multicenter, retrospective study of 275 benign thyroid nodules in 240 patients who underwent treatment with radiofrequency ablation (RFA) between November 2018 and March 2022.
The study included 240 patients (82.2% women) with 275 benign nodules (191 nonfunctional). Median age was 50 years (interquartile range [IQR] 22.5). After a mean (SD) follow-up of 186.1 (138.7) days, most patients experienced a 50% or more reduction in nodule volume after RFA, with a median volume reduction percentage (VRP) of 63.5% (IQR 48.1%-75.16%), and median absolute volume reduction (AVR) of 6.54 mL (IQR 2.85-14.97). Factors that predict AVR post RFA are female sex, ethnicity, and larger nodule volume before RFA and inversely duration of ablation time. Factors that predict VRP post RFA are age, non-Hispanic ethnicity, American Thyroid Association category very low risk and low risk, higher energy, and pre-RFA thyrotropin level. In a subgroup analysis of autonomously functioning thyroid nodules (AFTNs), the strongest predictor for achieving a normal thyroid function test was the severity of hyperthyroidism before the procedure, with better performance in subclinical hyperthyroidism.
Our study suggests that larger nodules may still have successful ablation with higher AVR. A longer time of ablation or higher energy delivered may indicate a less responsive thyroid nodule, hence lower AVR and VRP. In AFTN, severity of hyperthyroidism is the strongest predictor of achieving normal euthyroid state post RFA.
鉴于射频消融在良性甲状腺结节治疗中的应用日益广泛，识别预测成功治疗结果的因素对于优化患者选择越来越重要。
本研究旨在寻找影响良性甲状腺结节射频消融术后体积缩小（VR）的潜在因素。
这是一项多中心回顾性研究，研究对象为240例患者的275个良性甲状腺结节，这些患者在2018年11月至2022年3月期间接受了射频消融（RFA）治疗。
该研究纳入了240例患者（82.2%为女性），共275个良性结节（191个无功能结节）。中位年龄为50岁（四分位间距[IQR]为22.5）。平均（标准差）随访186.1（138.7）天，大多数患者在RFA术后结节体积缩小50%或更多，体积缩小百分比（VRP）中位数为63.5%（IQR为48.1%-75.16%），绝对体积缩小（AVR）中位数为6.54 mL（IQR为2.85-14.97）。预测RFA术后AVR的因素包括女性、种族、RFA术前较大的结节体积，以及与消融时间呈反比。预测RFA术后VRP的因素包括年龄、非西班牙裔种族、美国甲状腺协会极低风险和低风险类别、更高的能量，以及RFA术前促甲状腺激素水平。在自主功能性甲状腺结节（AFTN）的亚组分析中，术前甲状腺功能亢进的严重程度是实现甲状腺功能测试正常的最强预测因素，在亚临床甲状腺功能亢进中表现更好。
我们的研究表明，较大的结节通过更高的AVR仍可能成功消融。更长的消融时间或更高的能量输送可能表明甲状腺结节反应较差，因此AVR和VRP较低。在AFTN中，甲状腺功能亢进的严重程度是RFA术后实现正常甲状腺功能状态的最强预测因素。
