Skip to main content

Advertisement

SpringerLink
Log in

Efficacy and safety of thermal ablation for autonomously functioning thyroid nodules: a systematic review and meta-analysis

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background

Although thermal ablation has been regarded as an alternative treatment option for autonomously functioning thyroid nodules (AFTNs), the efficacy of this treatment in patients with AFTNs has not yet been systematically evaluated. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of thermal ablation in the treatment of AFTN, and identify the factors affecting the effectiveness of the treatment.

Methods

Ovid-MEDLINE and Embase databases were searched for studies reporting the efficacy and safety of thermal ablation for patients with AFTN published up until January 6, 2020. Data extraction and quality assessment were performed by two radiologists according to PRISMA guidelines. The primary and secondary outcomes were to yield the pooled proportions of thyroid-stimulating hormone (TSH) normalization and pooled estimates of volume reduction rate (VRR), respectively. Subgroup analyses were performed to identify factors affecting the treatment efficacy.

Results

This systematic review identified 411 AFTNs treated by thermal ablation in 391 patients in 14 studies. TSH normalization was achieved in 71.2% of patients and the volume reduction rate was 69.4% at a mean follow-up period of 12.8 months. No patients experienced hypothyroidism or a life-threatening complication during follow-up. Subgroup analyses according to nodule volume did not find a significant difference in TSH normalization (p = 0.54) or VRR (p = 0.94).

Conclusions

Thermal ablation is an effective and safe treatment method for patients with AFTNs. The nodule volume did not affect the efficacy of thermal ablation, and this result should be considered in future thermal ablation guidelines.

Key Points

• Thermal ablation has good efficacy and safety in the treatment of autonomously functioning thyroid nodule.

• The efficacy of thermal ablation was not affected by nodule volume.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Burch HB, Shakir F, Fitzsimmons TR, Jaques DP, Shriver CD (1998) Diagnosis and management of the autonomously functioning thyroid nodule: the Walter Reed Army Medical Center experience, 1975-1996. Thyroid 8:871–880

    CAS  PubMed  Google Scholar 

  2. Hegedus L (2004) Clinical practice. The thyroid nodule. N Engl J Med 351:1764–1771

    PubMed  Google Scholar 

  3. Ferrari C, Reschini E, Paracchi A (1996) Treatment of the autonomous thyroid nodule: a review. Eur J Endocrinol 135:383–390

    CAS  PubMed  Google Scholar 

  4. Gharib H, Papini E, Garber JR et al (2016) 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. Endocr Pract 22:622–639

    PubMed  Google Scholar 

  5. Amabile G, Rotondi M, Pirali B et al (2011) Interstitial laser photocoagulation for benign thyroid nodules: time to treat large nodules. Lasers Surg Med 43:797–803

    PubMed  Google Scholar 

  6. Baek JH, Moon WJ, Kim YS, Lee JH, Lee D (2009) Radiofrequency ablation for the treatment of autonomously functioning thyroid nodules. World J Surg 33:1971–1977

    PubMed  Google Scholar 

  7. Barbaro D, Orsini P, Lapi P et al (2007) Percutaneous laser ablation in the treatment of toxic and pretoxic nodular goiter. Endocr Pract 13:30–36

    PubMed  Google Scholar 

  8. Bernardi S, Stacul F, Michelli A et al (2017) 12-Month efficacy of a single radiofrequency ablation on autonomously functioning thyroid nodules. Endocrine 57:402–408

    CAS  PubMed  Google Scholar 

  9. Cervelli R, Mazzeo S, Boni G et al (2019) Comparison between radioiodine therapy and single-session radiofrequency ablation of autonomously functioning thyroid nodules: a retrospective study. Clin Endocrinol (Oxf) 90:608–616

    CAS  Google Scholar 

  10. Cesareo R, Naciu AM, Iozzino M et al (2018) Nodule size as predictive factor of efficacy of radiofrequency ablation in treating autonomously functioning thyroid nodules. Int J Hyperthermia 34:617–623

    CAS  PubMed  Google Scholar 

  11. Dobnig H, Amrein K (2018) Monopolar radiofrequency ablation of thyroid nodules: a prospective austrian single-center study. Thyroid 28:472–480

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Dossing H, Bennedbaek FN, Bonnema SJ, Grupe P, Hegedus L (2007) Randomized prospective study comparing a single radioiodine dose and a single laser therapy session in autonomously functioning thyroid nodules. Eur J Endocrinol 157:95–100

    PubMed  Google Scholar 

  13. Faggiano A, Ramundo V, Assanti AP et al (2012) Thyroid nodules treated with percutaneous radiofrequency thermal ablation: a comparative study. J Clin Endocrinol Metab 97:4439–4445

    CAS  PubMed  Google Scholar 

  14. Gambelunghe G, Stefanetti E, Colella R, Monacelli M, Avenia N, De Feo P (2018) A single session of laser ablation for toxic thyroid nodules: three-year follow-up results. Int J Hyperthermia 34:631–635

    PubMed  Google Scholar 

  15. Spiezia S, Garberoglio R, Milone F et al (2009) Thyroid nodules and related symptoms are stably controlled two years after radiofrequency thermal ablation. Thyroid 19:219–225

    PubMed  Google Scholar 

  16. Sung JY, Baek JH, Jung SL et al (2015) Radiofrequency ablation for autonomously functioning thyroid nodules: a multicenter study. Thyroid 25:112–117

    CAS  PubMed  Google Scholar 

  17. Kim JH, Baek JH, Lim HK et al (2018) 2017 Thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. Korean J Radiol 19:632–655

    PubMed  PubMed Central  Google Scholar 

  18. Dobnig H, Zechmann W, Hermann M et al (2020) Radiofrequency ablation of thyroid nodules: “Good Clinical Practice Recommendations” for Austria: an interdisciplinary statement from the following professional associations: Austrian Thyroid Association (OSDG), Austrian Society for Nuclear Medicine and Molecular Imaging (OGNMB), Austrian Society for Endocrinology and Metabolism (OGES), Surgical Endocrinology Working Group (ACE) of the Austrian Surgical Society (OEGCH). Wien Med Wochenschr 170:6–14

    PubMed  Google Scholar 

  19. Garberoglio R, Aliberti C, Appetecchia M et al (2015) Radiofrequency ablation for thyroid nodules: which indications? The first Italian opinion statement. J Ultrasound 18:423–430

    PubMed  PubMed Central  Google Scholar 

  20. Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:W65–W94

    PubMed  Google Scholar 

  21. Baek JH, Kim YS, Lee D, Huh JY, Lee JH (2010) Benign predominantly solid thyroid nodules: prospective study of efficacy of sonographically guided radiofrequency ablation versus control condition. AJR Am J Roentgenol 194:1137–1142

    PubMed  Google Scholar 

  22. Papini E, Rago T, Gambelunghe G et al (2014) Long-term efficacy of ultrasound-guided laser ablation for benign solid thyroid nodules. Results of a three-year multicenter prospective randomized trial. J Clin Endocrinol Metab 99:3653–3659

    CAS  PubMed  Google Scholar 

  23. Ahmed M, Solbiati L, Brace CL et al (2014) Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 25:1691–1705.e1694

    PubMed  PubMed Central  Google Scholar 

  24. Baek JH, Lee JH, Sung JY et al (2012) Complications encountered in the treatment of benign thyroid nodules with US-guided radiofrequency ablation: a multicenter study. Radiology 262:335–342

    PubMed  Google Scholar 

  25. Kim C, Lee JH, Choi YJ, Kim WB, Sung TY, Baek JH (2017) Complications encountered in ultrasonography-guided radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers. Eur Radiol 27:3128–3137

    PubMed  Google Scholar 

  26. Kim SY, Park JE, Lee YJ et al (2013) Testing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validity. J Clin Epidemiol 66:408–414

    PubMed  Google Scholar 

  27. Kim SY, Seo HJ, Lee YJ, Park JE (2013) Study design algorithm for medical literature of intervention (DAMI) and Risk of bias for nonrandomized studies (Robans) ver 2.0 by HIRA. Health Insurance Review & Assessment Service, Seoul

    Google Scholar 

  28. Kim KW, Lee J, Choi SH, Huh J, Park SH (2015) Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part I. General guidance and tips. Korean J Radiol 16:1175–1187

    PubMed  PubMed Central  Google Scholar 

  29. Lee J, Kim KW, Choi SH, Huh J, Park SH (2015) Systematic review and meta-analysis of studies evaluating diagnostic test accuracy: a practical review for clinical researchers-part II. Statistical methods of meta-analysis. Korean J Radiol 16:1188–1196

    PubMed  PubMed Central  Google Scholar 

  30. Suh CH, Park SH (2016) Successful publication of systematic review and meta-analysis of studies evaluating diagnostic test accuracy. Korean J Radiol 17:5–6

    PubMed  PubMed Central  Google Scholar 

  31. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    PubMed  PubMed Central  Google Scholar 

  32. Chianelli M, Bizzarri G, Todino V et al (2014) Laser ablation and 131-iodine: a 24-month pilot study of combined treatment for large toxic nodular goiter. J Clin Endocrinol Metab 99:E1283–E1286

    CAS  PubMed  Google Scholar 

  33. Negro R, Greco G (2019) Quality of life and outcomes in patients with a large toxic adenoma undergoing laser ablation plus radioiodine vs lobectomy. Int J Hyperthermia 36:191–195

    PubMed  Google Scholar 

  34. Pacella CM, Bizzarri G, Guglielmi R et al (2000) Thyroid tissue: US-guided percutaneous interstitial laser ablation-a feasibility study. Radiology 217:673–677

    CAS  PubMed  Google Scholar 

  35. Spiezia S, Vitale G, Di Somma C et al (2003) Ultrasound-guided laser thermal ablation in the treatment of autonomous hyperfunctioning thyroid nodules and compressive nontoxic nodular goiter. Thyroid 13:941–947

    PubMed  Google Scholar 

  36. Deandrea M, Limone P, Basso E et al (2008) US-guided percutaneous radiofrequency thermal ablation for the treatment of solid benign hyperfunctioning or compressive thyroid nodules. Ultrasound Med Biol 34:784–791

    PubMed  Google Scholar 

  37. Cappelli C, Franco F, Pirola I et al (2019) Radiofrequency ablation of functioning and non-functioning thyroid nodules: a single institution 12-month survey. J Endocrinol Invest. https://doi.org/10.1007/s40618-019-01132-4

  38. Feldkamp J, Grunwald F, Luster M, Lorenz K, Vorlander C, Fuhrer D (2020) Non-surgical and non-radioiodine techniques for ablation of benign thyroid nodules: consensus statement and recommendation. Exp Clin Endocrinol Diabetes. https://doi.org/10.1055/a-1075-2025

  39. Papini E, Pacella CM, Solbiati LA et al (2019) Minimally-invasive treatments for benign thyroid nodules: a Delphi-based consensus statement from the Italian minimally-invasive treatments of the thyroid (MITT) group. Int J Hyperthermia 36:376–382

    PubMed  Google Scholar 

  40. Kim JH, Baek JH, Lim HK, Na DG (2019) Summary of the 2017 thyroid radiofrequency ablation guideline and comparison with the 2012 guideline. Ultrasonography 38:125–134

    PubMed  Google Scholar 

  41. Mauri G, Nicosia L, Della Vigna P et al (2019) Percutaneous laser ablation for benign and malignant thyroid diseases. Ultrasonography 38:25–36

    PubMed  Google Scholar 

  42. Chung SR, Baek JH, Choi YJ et al (2019) The role of core needle biopsy for the evaluation of thyroid nodules with suspicious ultrasound features. Korean J Radiol 20:158–165

    PubMed  Google Scholar 

  43. Giovanella L, Piccardo A, Pezzoli C et al (2018) Comparison of high intensity focused ultrasound and radioiodine for treating toxic thyroid nodules. Clin Endocrinol (Oxf) 89:219–225

    Google Scholar 

  44. Kotewall N, Lang BHH (2019) High-intensity focused ultrasound ablation as a treatment for benign thyroid diseases: the present and future. Ultrasonography 38:135–142

    PubMed  Google Scholar 

  45. Hahn SY, Shin JH, Na DG et al (2019) Ethanol ablation of the thyroid nodules: 2018 consensus statement by the Korean Society of Thyroid Radiology. Korean J Radiol 20:609–620

    PubMed  PubMed Central  Google Scholar 

  46. Che Y, Jin S, Shi C et al (2015) Treatment of benign thyroid nodules: comparison of surgery with radiofrequency ablation. AJNR Am J Neuroradiol 36:1321–1325

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Papini E, Gugliemi R, Pacella CM (2016) Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules. Curr Opin Endocrinol Diabetes Obes 23:400–406

    CAS  PubMed  Google Scholar 

  48. Haugen BR, Alexander EK, Bible KC et al (2016) 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. Thyroid 26:1–133

    PubMed  PubMed Central  Google Scholar 

  49. Sim JS, Baek JH (2019) Long-term outcomes following thermal ablation of benign thyroid nodules as an alternative to surgery: the importance of controlling regrowth. Endocrinol Metab (Seoul) 34:117–123

    PubMed  PubMed Central  Google Scholar 

  50. Pacella CM, Mauri G (2018) Is there a role for minimally invasive thermal ablations in the treatment of autonomously functioning thyroid nodules? Int J Hyperthermia 34:636–638

    PubMed  Google Scholar 

Download references

Funding

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

Author information

Author notes

  1. Hyun Jin Kim and Se Jin Cho contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam, Gyeonggi, Republic of Korea

    Hyun Jin Kim

  2. Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, Republic of Korea

    Se Jin Cho

  3. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Jung Hwan Baek & Chong Hyun Suh

Authors
  1. Hyun Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Se Jin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung Hwan Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chong Hyun Suh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung Hwan Baek.

Ethics declarations

Guarantor

Scientific guarantor of this publication: Jung Hwan Baek, Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center.

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 not required for this study because this study performed only systematic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this study performed only systematic review and meta-analysis.

Methodology

• systematic review

• meta-analysis

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 19 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, H.J., Cho, S.J., Baek, J.H. et al. Efficacy and safety of thermal ablation for autonomously functioning thyroid nodules: a systematic review and meta-analysis. Eur Radiol 31, 605–615 (2021). https://doi.org/10.1007/s00330-020-07166-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07166-0

Keywords

Search

Navigation