Background: Nodular goiter is one of the commonest endocrinopathy. Its incidence increases with age accounting for more than 50% of subjects older than 60 years. Elderly subjects more frequently suffer from pressure symptoms. Loco-regional treatments, like laser photocoagulation and percutaneous ethanol injection, are a potentially useful tool to treat TNs but their efficacy is still debated. Radiofrequency thermal ablation (RTA) has been applied to several benign and malignant tumors proving to be a safe procedure, potentially helpful to stabilize or decrease tumor growth. Recently, RTA proved to be safe and to induce short-time effects in the treatment of patients with thyroid nodules.
Objective: The aim of this study is to evaluate safety and efficacy of RTA in elderly patients with compressive thyroid nodules followed-up for 1 year.
Patients and methods: Thirty-nine elderly patients with cytologically benign compressive TNs were enrolled in the study. Twenty-seven of them were affected with nontoxic goiter, five with pre-toxic goiter, four with toxic goiter, three with toxic adenoma. Thyroid surgery was contraindicated in 22 and refused in 17 cases. RTA was performed by using a RITA © Starbust needle inserted under ultrasonographic real time guide. Efficacy and safety of RTA were followed-up at 1, 3, 6, 12 month.
Results: After treatment, all TNs showed a significant decrease during the follow-up. Mean TN volume decreased from 24.3±2.6 to 6.4±1.6 ml (P<0.001) with a mean percent decrease of 78.6±2.5% 12 months after RTA. Compressive symptoms improved in all cases and disappeared in 82%. The treatment was well tolerated by all patients. No major complications were observed.
Conclusions: RTA seems to be a valid and safe approach in the treatment of benign thyroid nodules with pressure symptoms. RTA may be of great benefit in elderly patients in whom surgery or radio-iodine therapy are contraindicated or refused.