Efficacy and Safety of Radiofrequency Thermal Ablation in the Treatment of Thyroid Nodules With Pressure Symptoms in Elderly Patients

To the Editor: Thyroid nodules (TNs) are found in more than 50% of elderly people. The great majority of TNs are benign, but they can often be responsible for pressure symptoms in the neck1 and result in discomfort and decreased quality of life. If untreated, large compressive TNs may result in life-threatening conditions because of the potential acute onset of respiratory crisis.2 Thyroid surgery and radioiodine therapy are the main therapeutic approaches for compressive TNs,1,3 although the risk of mortality and morbidity for thyroid surgery is greater in elderly patients.4 Furthermore, hypothyroidism may follow surgery and radioiodine therapy and complicate preexisting chronic disorders in many elderly patients.5 Of percutaneous ablative procedures, ethanol injection is quite efficacious in cystic but not in solid nodules,1 whereas laser ablation is reported to induce a 6-month TN decrease of 40% to 60%, although local adverse events may occur.6 Alternatively, radiofrequency thermal ablation (RTA) is a consolidated, safe, and simple approach for percutaneous treatment of tumor lesions within the liver.7 Recently, RTA has been proposed for the treatment of TNs.8 For these reasons, efficacy and safety of RTA in elderly subjects with compressive TNs were investigated, and preliminary data are briefly reported here. Thirty-nine elderly patients with cytologically benign compressive TNs underwent one to three cycles of RTA performed using a hook umbrella (Starburst, RITA Medical Systems, Mountain View, CA) under ultrasonographic real time guide. After RTA ablation, TN volume was significantly decreased from baseline (P < .001) (Figure 1). TN volume decrease was stable during the follow-up, resulting in a decrease of 74% 6 months after RTA. Pressure symptoms in the neck, such as difficulty in swallowing and tracheal displacement, improved in all patients, with complete symptom disappearance in most. All patients tolerated the treatment well. No patient needed hospitalization after RTA, and no major complication was observed. These preliminary data show that RTA is a safe, simple, and effective procedure to treat TNs with pressure symptoms in elderly subjects. Thyroid nodule volume (mean ± standard error of the mean) at baseline and 6 months after treatment with radiofrequency thermal ablation in patients with compressive thyroid nodules. RTA has been previously demonstrated to manage hepatic lesions effectively.7 A recent study performed on 30 patients with TNs treated with RTA reported short-time suppressive effects predominantly in cystic TNs and low efficacy in solid TNs with scarce or absent cystic component.8 To the contrary, it was demonstrated in the current study that RTA induced shrinkage of most solid TNs. The use in the current study of a hook umbrella capable of necrotizing up to 5 cm around the electrode needle may explain this discrepancy. RTA can be considered safer than other percutaneous ablative procedures, because no local adverse events were noticed. In conclusion, percutaneous RTA seems to show a high benefit-risk ratio in the treatment of elderly patients with compressive TNs and may represent a valid alternative to conventional treatments that may be contraindicated or ineffective in this population. Financial Disclosure: None. Author Contributions: The study was conceived by Stefano Spiezia and designed by Stefano Spiezia and Antongiulio Faggiano. The RTA procedure applied to the thyroid nodule was defined by Stefano Spiezia, Roberto Garberoglio, Maurilio Deandrea, Edoardo Basso, Paolo P. Limone. Acquisition of data was performed by Stefano Spiezia, Roberto Garberoglio, Maurilio Deandrea, Edoardo Basso, Paolo P. Limone, Francesco Milone, Valeria Ramundo. Statistical analysis and data interpretation were performed by Antongiulio Faggiano, Carolina Di Somma, Paolo E. Macchia. Text manuscript was prepared by Antongiulio Faggiano, Stefano Spiezia, Carolina Di Somma, and Paolo Macchia and critically revised and supervised by Annamaria Colao, Gaetano Lombardi, and Bernadette Biondi for important intellectual contributions. Figures were prepared by Antongiulio Faggiano and Stefano Spiezia. Sponsor's Role: No sponsor.