Roberto Valcavi¹* and Alessandro Serblin²

¹The Endocrine and Thyroid Clinic, Department of Endocrinology, Reggio Emilia, Italy
²Department of Otolaryngology, Head and Neck Surgery Unit, University Hospital of Ferrara, Ferrara, Italy

*Corresponding Author: Roberto Valcavi, The Endocrine and Thyroid Clinic, Department of Endocrinology, Reggio Emilia, Italy.

Received: April 01, 2025; Published: May 16, 2025

Abstract

This chapter reviews the different thermal ablation techniques for benign thyroid nodules, in particular it discusses the radiofrequency ablation (RFA) technique with its advantages and disadvantages, and also emphasises the importance of protecting adjacent nerve structures, such as the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN). In addition, important aspects of RFA ablation procedures are described, such as hydrodissection, rescue techniques to avoid nerve damage, local anaesthesia and sedation. Guidelines and training for RFA, clinical settings, informed patient consent and expected outcomes and benefits for patients undergoing RFA procedures on benign thyroid nodules are also outlined.

Keywords: Radiofrequency Ablation (RFA); Recurrent Laryngeal Nerve (RLN)

References

1. Dean DS and Gharib H. “Epidemiology of thyroid nodules”. Best Practice and Research Clinical Endocrinology and Metabolism6 (2008): 901-911.
2. Gharib H., et al. “American Association of Clinical Endocrinologists, American College of Endocrinology, and Associazione Medici Endocrinologi medical guidelines for clinical practice for the diagnosis and management of thyroid nodules— 2016 update”. Endocrine Practice5 (2016): 622-639.
3. Meltzer C., et al. “Association between annual surgeon total thyroidectomy volume and transient and permanent complications”. JAMA Otolaryngology – Head and Neck Surgery 9 (2019): 830.
4. Sosa JA., et al. “Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States”. Surgery6 (2013): 1420-1427.
5. Lisa A Orloff., et al. “Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: an international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association”. Head Neck3 (2021): 633-660.
6. Ahn D., et al. “Hypothyroidism following hemithyroidectomy: incidence, risk factors, and clinical characteristics”. The Journal of Clinical Endocrinology and Metabolism4 (2016): 1429-1436.
7. Ha EJ., et al. “2021 Korean thyroid imaging reporting and data system and imaging-based management of thyroid nodules: Korean society of thyroid radiology consensus statement and recommendations”. Korean Journal of Radiology12 (2021): 2094.
8. Bryan R Haugen., et al. “2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer”. Thyroid1 (2016): 1-133.
9. Cheng Z and Liang P. “Advances in ultrasound-guided thermal ablation for symptomatic benign thyroid nodules”. Advances in Clinical and Experimental Medicine 9 (2020): 1123-1129.
10. Chu KF and Dupuy DE. “Thermal ablation of tumours: biological mechanisms and advances in therapy”. Nature Reviews Cancer3 (2014): 199-208.
11. H Petra Kok., et al. “Heating technology for malignant tumors: a review”. International Journal of Hyperthermia 1 (2020): 711-741.
12. Se Jin Cho., et al. “Long-Term Results of Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis”. Endocrinology and Metabolism 35 (2020): 339-350.
13. Sim JS and Baek JH. “Long-term outcomes following thermal ablation of benign thyroid nodules as an alternative to surgery: the importance of controlling regrowth”. Endocrinology and Metabolism (Seoul)2 (2019): 117-123.
14. Hao Jin., et al. “A Propensity Score Matching Study Between Microwave Ablation and Radiofrequency Ablation in Terms of Safety and Efficacy for Benign Thyroid Nodule Treatment”. Thyroid Endocrinology 12 (2021).
15. Xiaofei Jin., et al. “Temperature control and intermittent time-set protocol optimization for minimizing tissue carbonization in microwave ablation”. International Journal of Hyperthermia1 (2022): 868-879.
16. Nicholas Kotewall., et al. “High-intensity focused ultrasound ablation as a treatment for benign thyroid diseases: the present and future”. Department of Surgery, The University of Hong Kong, Hong Kong SAR, China. Ultrasonography 38 (2019): 135-140.
17. Kim YS., et al. “Radiofrequency ablation of benign cold thyroid nodules: initial clinical experience”. Thyroid 4 (2006): 361-367.
18. Kim JH., et al. “Guideline Committee for the Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology”. Korean Journal of Radiology4 (2017): 632-655.
19. Garberoglio R., et al. “Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement”. Journal of Ultrasound4 (2015): 423-430.
20. Wang N., et al. “Thyroid dysfunction following radiofrequency ablation for benign thyroid nodules: more likely to occur within one-week and in high-risk population”. International Journal of Hyperthermia1 (2021): 1060-1068.
21. Deandrea M., et al. “Efficacy and safety of radiofrequency ablation versus observation for nonfunctioning benign thyroid nodules: a randomized controlled international collaborative trial”. Thyroid 25.8 (2015): 890-896.
22. Jung SL., et al. “Efficacy and safety of radiofrequency ablation for benign thyroid nodules: a prospective multicenter study”. Korean Journal of Radiology1 (2018): 167-174.
23. Kuo JH., et al. “Analyzing the adoption of radiofrequency ablation of thyroid nodules using the diffusion of innovations theory: understanding where we are in the United States?” Ultrasonography 1 (2022): 25-33.
24. Jasim S., et al. “American Association of Clinical Endocrinology disease state clinical review: the clinical utility of minimally invasive interventional procedures in the management of benign and malignant thyroid lesions”. Endocrine Practice4 (2022): 433-448.
25. Y Che., et al. “Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation”. American Journal of Neuroradiology 36 (2021): 1321-1325.
26. Valcavi R and Tsamatropoulos P. “Health-Related Quality of Life after Percutaneous Radiofrequency Ablation of Cold, Solid, Benign Thyroid Nodules: a Two-year Follow-up Study in 40 Patients”. Endocrine Practice8 (2015): 887-896.
27. Sinclair CF., et al. “Continuous neuromonitoring during radiofrequency ablation of benign thyroid nodules provides objective evidence of laryngeal nerve safety”. American Journal of Surgery2 (2021): 354-360.
28. Randolph GW., et al. “The International RLN Anatomic Classification System”. In: Randolph, G. (eds) The Recurrent and Superior Laryngeal Nerves. Springer, Cham (2016).
29. Jung Hwan Baek., et al. “Complications Encountered in the Treatment of Benign Thyroid Nodules with US-guided Radiofrequency Ablation: A Multicenter Study”. Radiology 1 (2012): 335-342.
30. So Yeong Jeong., et al. “Radiofrequency ablation of benign thyroid nodules: the value of anterolateral hydrodissection”. Ultrasonography 42 (2023): 432-439.
31. Yanping Ma., et al. “Continuous, Large-Volume Hydrodissection to Protect Delicate Structures around the Thyroid throughout the Radiofrequency Ablation Procedure”. European Thyroid Journal 10 (2021): 495-503.
32. Eun Ju Ha., et al. “Ultrasonography-Based Thyroidal and Perithyroidal Anatomy and Its Clinical Significance. Korean Journal of Radiology4 (2015): 749–766.
33. Chung SR., et al. “Management strategy for nerve damage during radiofrequency ablation of thyroid nodules”. International Journal of Hyperthermia1 (2019): 204-210.
34. Jee Young Kim., et al. “Differentiation of benign and malignant thyroid nodules based on the proportion of sponge-like areas on ultrasonography: imaging-pathologic correlation”. Ultrasonography4 (2015): 304–311.
35. Cesareo R., et al. “Efficacy of radiofrequency and laser thermal ablation in solving thyroid nodule-related symptoms and cosmetic concerns. A systematic review and meta analysis”. Reviews in Endocrine and Metabolic Disorders 5 (2022): 1051-1061.
36. Lee M., et al. “Clinical practice guidelines for radiofrequency ablation of benign thyroid nodules: a systematic review”. Ultrasonography2 (2020): 256-264.
37. Lang BHH and Fung MMH. “Safety and efficacy of single-session radiofrequency ablation treatment for benign non-toxic multinodular goiter”. World Journal of Surgery7 (2020): 1704-1710.
38. Chiang PL., et al. “Efficacy and safety of single session radiofrequency ablation for intrathoracic goiter: preliminary results and short-term evaluation”. International Journal of Hyperthermia1 (2021): 976-984.
39. Antônio Rahal Junior., et al. “The iceberg technique: an innovative approach for radiofrequency ablation of diving thyroid nodules”. Diagnostic and Interventional Radiology 4 (2023): 628–631.
40. Hussain I., et al. “Safety and efficacy of radiofrequency ablation of thyroid nodules—expanding treatment options in the United States”. Journal of Endocrine Society8 (2021): bvab110.
41. Cesareo R., et al. “Radiofrequency ablation on autonomously functioning thyroid nodules: a critical appraisal and review of the literature”. Frontiers in Endocrinology (Lausanne) 11 (2020): 317.
42. Jung Hwan Baek., et al. “Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules”. World Journal of Surgery9 (2009): 1971-1977.
43. Valcavi R., et al. “Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation”. Video Endocrinology 10.3 (2023): 41–43.
44. James Y Lim., et al. “Thyroid Nodule Radiofrequency Ablation: Complications and Clinical Follow Up”. Techniques in Vascular and Interventional Radiology 25 (2021): 100824.
45. Peter P Issa., et al. “Radiofrequency ablation of thyroid nodules: a clinical review of treatment complications”. Gland Surgery1 (2024): 77-86.
46. Chung SR., et al. “Revisiting rupture of benign thyroid nodules after radiofrequency ablation: various types and imaging features”. Endocrinology and Metabolism4 (2019): 415-421.
47. Baek JH., et al. “Complications encountered in the treatment of benign thyroid nodules with us-guided radiofrequency ablation: a multicenter study”. Radiology1 (2012): 335-342.
48. Bernardi S., et al. “Five-year results of radiofrequency and Laser ablation of benign thyroid nodules: a multicenter study from the Italian Minimally Invasive Treatments of the Thyroid Group”. Thyroid 12 (2020): 1759-1770.
49. Jeong SY., et al. “Assessment of thyroid-specific quality of life in patients with benign symptomatic thyroid nodules treated with radiofrequency or ethanol ablation: a prospective multicenter study”. Ultrasonography 1 (2022): 204-211.
50. Jawad S., et al. “Ultrasound-guided radiofrequency ablation (RFA) of benign symptomatic thyroid nodules—initial UK experience”. British Journal of Radiology1098 (2019): 20190026.
51. Cesareo R., et al. “Prospective study of effectiveness of ultrasound-guided radiofrequency ablation versus control group in patients affected by benign thyroid nodules”. The Journal of Clinical Endocrinology and Metabolism2 (2015): 460-466.
52. Valcavi R., et al. “Soft-Boiled Quail Egg: Phantom Model for Thyroid Radiofrequency Ablation Training”. VideoEndocrinology4 (2023).
53. Sparano C., et al. “Clinical impact of the new SIAPEC-IAP classification on the indeterminate category of thyroid nodules”. Journal of Endocrinological Investigation1 (2019): 1-6.

Citation

Citation: Roberto Valcavi and Alessandro Serblin. “Radiofrequency Ablation (RA) of Benign Thyroid Nodules".Acta Scientific Otolaryngology 7.6 (2025): 18-32.

Copyright

Copyright: © 2025 Roberto Valcavi and Alessandro Serblin. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.