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Shin: Non-surgical, Image-guided Management of Benign Thyroid Nodules
Review Article

Clin Exp Thyroidol 2014;7(2):111-117.

Published online: 7 November 2014

DOI: https://doi.org/10.11106/cet.2014.7.2.111

Non-surgical, Image-guided Management of Benign Thyroid Nodules

Jung Hee Shin

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence: Jung Hee Shin, MD, PhD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea Tel: 82-2-3410-0511, Fax: 82-2-3410-0084, E-mail: jhshin11@skku.edu

Received 7 May 2013       Accepted 18 October 2013

Copyright © 2014, the Korean Thyroid Association.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Most thyroid nodules are cytologically benign and can be managed nonsurgically. Asymptomatic benign nodules require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for treatment. Until now in clinical practices, nonsurgical image-guided therapy includes percutaneous ethanol injection, radiofrequency ablation, laser ablation, and high intensity focused ultrasound. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Radiofrequency ablation is an effective procedure for obtaining shrinkage and improving symptoms of solid thyroid nodules. Better understanding of image-guided therapy makes physicians personalize the management of benign thyroid nodules according to a cost-benefit analysis.

Keywords: Thyroid nodule, Ultrasonography, Radiofrequency ablation

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Fig. 1.
A 38-year-old female patient with visible protruded thyroid mass underwent ethanol injection. A 3.9 cm sized cystic nodule (20.1 mL in volume) is seen in the right thyroid gland (A; transverse image, B; longitudinal image). This cystic nodule (arrows) was markedly decreased to 1.6 cm (0.47 mL in volume) 8 months after ethanol ablation (C; transverse image, D; longitudinal image). Volume reduction rate was 97.7%. Her symptom and cosmetic problem were improved.
jkta-7-111f1.tif
Fig. 2.
A 3.9 cm sized solid thyroid nodule (9.0 mL in volume) is noted in the left thyroid gland (A; transverse image, B; longitudina image). Echogenic bubbles (arrows) occur from the tip of the electrode during active radiofrequency ablation (C). Hypoechoic change with echogenic portion of entire nodule indicates acceptable ablation (D). At 3 years after ablation, volume reduction rate of nodule (arrows) was 95.6% (E; transverse image, F; longitudinal image).
jkta-7-111f2.tif
Table 1
Treatment results of radiofrequency ablation for benign thyroid nodules
Author (Published year) No. of nodules Nodule type Follow–up (months) VR (%) Mean No. of session
Kim et al. (2006) 30 cold 1–18 64 1
Jeong et al. (2008) 236 cold 1–41 84 1.4 (1–6)
Deandrea et al. (2008) 31 cold + AFTN 6 51 1
Spiezia et al. (2009) 94 cold + AFTN 12–24 79 1.4 (1–3)
Baek et al. (2009) 9 AFTN 6–17 75 2.2 (1–4)
Baek et al. (2009) 15 cold 6–8 80 1
Lee et al. (2010) 27 cold 6–38 97 1.6 (1–4)

AFTN: autonomously functioning thyroid nodule, VR: volume reduction

Data were adapted from Baek et al.27)

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