Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 patients over a 10-Year Period

Clinical question
Is it safe and effective to perform radiofrequency ablation for nonfunctioning benign thyroid nodules in children and adolescents?

Take-away point
RFA is likely safe and effective for the treatment of nonfunctioning benign thyroid nodules in children and adolescents

Reference
Min Ji Hong, et al. Safety and Efficacy of Radiofrequency Ablation for Nonfunctioning Benign Thyroid Nodules in Children and Adolescents in 14 patients over a 10-Year Period. Journal of Vascular and Interventional Radiology. Jun3, 2019: 30; 6.

Click here for abstract

Study design

Retrospective

Funding source

Self-funded or unfunded

Setting

Single-center

Figure 1A 17-year-old female patient with a palpable nonfunctioning thyroid mass.

Summary

Currently, surgery is the preferred treatment method for pediatric thyroid nodules. Radiofrequency ablation (RFA) is rising in popularity for treatment of adult benign thyroid nodules. Ablation may be able to avoid risks associated with thyroid surgery, including hypothyroidism and vocal cord palsy, while still being able to reduce compressive and cosmetic problems caused by a benign nodule. This study evaluated a single center’s experience with using RFA in 14 pediatric patients.

All patients underwent biopsy to confirm benign pathology and had pressure symptoms or cosmetic problems secondary to the thyroid nodule. Ablation was performed with local anesthesia with ultrasound guidance using an 18-gauge 7 cm probe with a 0.5, 1, or 1.5 cm tip (Well-Point RF Electrodes). A moving shot technique was utilized, by placing the tip at the deepest portion of the nodule and withdrawn to the superficial aspect. A mean number of 2.1 treatment sessions were performed and no major complications were encountered. Over the mean follow up period of 36.9 months, the average nodule size was reduced from 3.7 cm pre-procedure to 1.7 cm on final follow up. Symptom and cosmetic scores were also significantly reduced from baseline. There was no significant change in serum thyroid levels.

Commentary

This is the first study evaluating ablation of benign nonfunctioning thyroid nodules in the pediatric population. While small in size, the study did demonstrate efficacy and safety. RFA may prove to be a preferred treatment for many benign nodules over surgery as it avoids hypothyroidism and minimizes the risk of recurrent laryngeal nerve damage. Additional benefits include avoidance of general anesthesia and absence of an incisional scar. A larger cohort would be needed to determine true complication rate, especially if performed by less experienced physicians. Thyroid ablation continues to be a growing field with numerous possible applications in the future.

Post Author

David M Mauro, MD
Assistant Professor
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina
@DavidMauroMD