Non-surgical management of thyroid nodules - the role of ablative therapies

[helvella]

Many here have asked about alternatives to surgery and radioactive iodine - and in some cases, there might be some. This paper seems to be supporting two specific options.

Have to say, the phrase "treatments of choice" sticks in my throat. Possibly they have been better than the depressingly bad alternative. But a forced choice is not a choice. Whether they are referring to the choice of the doctor or the patient.

I know both have been discussed a few times - this is not new. New papers do help with our arguments.

J Clin Endocrinol Metab

. 2021 Dec 25;dgab917.

doi: 10.1210/clinem/dgab917. Online ahead of print.

Non-surgical management of thyroid nodules - the role of ablative therapies

Marius N Stan 1 , Maria Papaleontiou 2 , John J Schmitz 3 , M Regina Castro 1

• PMID: 34953163

• DOI: 10.1210/clinem/dgab917

Abstract

Context: After a thorough evaluation most thyroid nodules are deemed of no clinical consequence and can be observed. However, when they are compressive, toxic, or involved by papillary thyroid carcinoma (PTC) surgery or RAI (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (e.g. scar, dysphonia, logistical limitation with RAI). Active surveillance might be used for papillary thyroid microcarcinoma (PTMC) initially, but anxiety leads many cases to surgery later. Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks.

Cases: We present 4 cases of thyroid lesions causing concerns (compressive symptoms, thyrotoxicosis, anxiety with active surveillance of PTMC). The common denominator is patients' attempt to preserve thyroid function, bringing into focus percutaneous ethanol injection (PEI) and thermal ablation techniques (radiofrequency ablation - RFA - being the most common). We discuss the evidence supporting these approaches and compare them with standard therapy, where evidence exists. We discuss additional considerations for the utilization of these therapies, their side-effects and conclude with a simplified description of how these procedures are performed.

Conclusions: Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice.

Keywords: papillary thyroid carcinoma; percutaneous ethanol injection; radiofrequency ablation; thermal ablation; thyroid nodule.

From <pubmed.ncbi.nlm.nih.gov/349...

[Gingernut44]

Thanks for posting this. I’ll have to read it later as I don’t want to spoil the day. Don’t get me started on “choice”. Suffice to say that, had I known about this forum four years ago, I wouldn’t be in the mess I’m in now.On a lighter note, I hope you had a happy Christmas and we can all look forward to a bright new year.

[humanbean]

My emphasis :

However, when they are compressive, toxic, or involved by papillary thyroid carcinoma (PTC) surgery or RAI (if toxic) are the treatments of choice. Both interventions can lead to hypothyroidism and other adverse outcomes (e.g. scar, dysphonia, logistical limitation with RAI).

I would love to know how often surgery and RAI don't lead to hypothyroidism.

[helvella Administrator Thyroid UK in reply to humanbean]

We have had a few who have had RAI and that had to be repeated because they continued to be hyperthyroid. But the end point, even if it took multiple attempts at RAI, would almost certainly be hypothyroidism, I do agree.