Background: Most thyroid nodules are benign and do not need intervention. Toxic adenoma and toxic multinodular goiter (MNG) are common causes of hyperthyroidism, second in prevalence only to Graves’ disease. Toxic adenoma and MNG are the result of focal or diffuse hyperplasia of thyroid follicular cells whose functional capacity is independent from regulation by the thyroid stimulating hormone (TSH). When conservative treatment modalities fail to ensure an euthyroid state, surgical intervention is required, typically surgical left or right thyroid lobectomy. Radiofrequency ablation (RFA) is a new percutaneous treatment option that results in thermal tissue necrosis and fibrosis. As a result of this process, the thyroid nodules shrink.
Case presentation: We describe a case of a young woman with a large toxic thyroid adenoma who refused surgery. She was admitted to a one-day surgery unit and underwent radiofrequency ablation under total intravenous anesthesia. Using “moving shot technique” the procedure went uneventfully and the toxic adenoma displayed a significant volume reduction with resolution of the hyperthyroid symptoms. The patient also reported a significant improvement of her neck symptoms (from 7/10 to 1/10 on a Visual Analogue Scale).
Conclusions: Radiofrequency ablation is a new, well tolerated, safe and effective treatment option in selected patients with benign thyroid nodules, toxic adenomas of the thyroid gland and multinodular goiter. To the best of our knowledge, this is the first time such treatment modality is used in Bulgaria.
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1. Doran H Palazzo F. Ambulatory thyroid surgery: Do the risks overcome the benefits? Presse Med. 2014; 43: 291-296.
2. Garberoglio R Aliberti C Appetecchia ML et al. Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound 2015;18:423-430.
3. Cibas ES Ali SZ. The Bethesda System for reporting Thyroid Cytopathology. Am J Clin Pathol 2009;132:658-665
4. Kim Ji-hoon Baek JH Lim HK et al. Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol 2017;19(4) 2018.
5. Haugen BR Alexander EK Bible KC et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Different Thyroid Cancer. THYROID 2016 26(1); 1-133.
6. Park HS Beak JH Park AW et al. Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques. Korean J Radiol 2017; 18(4): 615-623.
7. Oddo S Balestra M Vera L Guisti M. Benign Thyroid nodule unresponsive to Radiofrequency ablation treated with laser ablation: a case report. Journal of Medical Case Reports 2018; 12:127.
8. Mauri G Cova L Monaco C et al. Benign thyroid nodules treatment by percutaneous laser ablation and Radiofrequency ablation. Int J Hyperth. 2017;33:295-9.
9. Cesareo R Pasqualini V Simeoni C et al. Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules. J Clin Endocrinol Matab. 2015;100:460-6.
10. Gharib H Papini E Paschke R et al. Medical guidelines for clinical practice for the diagnosis and management of thyroid nodules: executive summary of recommendations. J Endocrinol Investig. 2010;33:287-91.
11. Ahn HS Kim SJ Park SH. Radiofrequency ablation of benign thyroid nodule evaluation of the treatment efficacy using ultrasonography. Ultrasonography. 2016;35:244-52.