European Radiology

, Volume 28, Issue 6, pp 2620–2627 | Cite as

Evaluation of pain during high-intensity focused ultrasound ablation of benign thyroid nodules

  • Brian H. H. LangEmail author
  • Yu-Cho Woo
  • Keith Wan-Hang Chiu
Head and Neck



To assess severity and factors of pain during high-intensity focused ultrasound (HIFU) ablation of benign thyroid nodules.


128 patients who underwent a HIFU ablation for a benign thyroid nodule were analysed. All patients received a bolus of intravenous pethidine and diazepam before treatment. After treatment, patients were asked to rate their overall pain experience on a visual analogue scale (0–100) (0 = no pain; 100 = worse possible pain) during treatment, 2 h after treatment and the following morning. Binary logistic regression was performed to evaluate associated factors for pain including patient demographics, nodule size, body mass index (BMI) and treatment parameters.


At T1, median (range) pain score was 65.0 (0.00–100.00). Only 16 (12.5 %) patients had a pain score of zero. In multivariate analysis, only lower BMI (OR 1.265, 95 % CI 1.102–1.452, p=0.001) and longer nodule diameter (OR 1.462, 95 % CI 1.071–1.996, p=0.017) were independent factors for pain score at T1 ≤ 65.0.


A moderate to severe amount of pain was reported during ablation of benign thyroid nodules in over 50 % of patients. Patients’ BMI and length of nodule diameter were independent variables for pain during HIFU ablation.

Key Points

Pain was moderate to severe during HIFU ablation of thyroid nodules.

Only one in eight patients reported no pain during ablation.

Level of energy per pulse did not affect pain.

Patients with lower BMI and larger nodules had less pain.


Interventional ultrasonography High-Intensity Focused Ultrasound ablation Pain management Nodular goitre Ablation techniques 



Body mass index


High-intensity focused ultrasound


Radiofrequency ablation




Visual analogue scale


Volume reduction ratio



We would like to thank Mr. Hill Yu for conducting all the pain assessments during and after HIFU treatment and Professor Stephen Cheng (Head of Department of Surgery, University of Hong Kong) for agreeing to be the guarantor of this paper.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Professor Stephen Cheng (Head of Department)

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Outcomes of some study subjects or cohorts have been previously reported but data on the appearance of hyperechoic marks have never been reported.


• Retrospective

• Observational

• Single institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Brian H. H. Lang
    • 1
    • 2
    Email author
  • Yu-Cho Woo
    • 3
  • Keith Wan-Hang Chiu
    • 4
  1. 1.Department of SurgeryThe University of Hong KongHong KongChina
  2. 2.Department of SurgeryQueen Mary HospitalHong KongChina
  3. 3.Department of MedicineThe University of Hong KongHong KongChina
  4. 4.Department of RadiologyThe University of Hong KongHong KongChina

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