Radiofrequency ablation (RFA)

Ultrasound-guided treatment for thyroid lesions is a minimally invasive outpatient treatment modality that can be an alternative to surgery in patients with benign thyroid nodules. In addition, it can also play an effective complementary role in the treatment of recurrent thyroid cancers. USG has demonstrated good efficacy and safety in the treatment of cosmetic problems related to thyroid nodules and pressure symptoms.

Most thyroid nodules are benign and asymptomatic; however, large thyroid nodules can cause cosmetic problems or symptoms of pressure in the neck, including pain, dysphasia, foreign body sensation, discomfort, neck swelling, and coughing. In these cases, RFA is indicated to improve clinical problems by reducing the size of the nodule. The size of a thyroid nodule or lobe appears to correlate directly with compressive symptoms. Most patients with compressive symptoms experienced improvement in symptoms after surgical removal of thyroid nodules and/or the thyroid gland. Therefore, nodules exceeding a maximum diameter of 2 cm and continuing to grow during the follow-up period may be considered for thyroid ARF based on symptoms, cosmetic issues, and clinical concerns. In addition, ARF is not available for thyroid nodules with large calcifications, because the moving-shot technique is difficult in this circumstance. Therefore, ARF should be carefully considered for these nodules.

Radiofrequency ablation can be performed for curative or palliative purposes in recurrent thyroid cancers in the thyroidectomy bed and cervical lymph nodes for patients at high surgical risk or who refuse surgery. (strong recommendation, moderate quality evidence).