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Ultrasound-guided radiofrequency ablation versus total thyroidectomy for benign solitary thyroid nodules by fine-needle aspiration cytology

Background Nodular disorders of the thyroid gland are frequently detected in the general population; most of these nodules are benign. However, malignant cases have been increasing in the past decades. Ultrasound is the most common imaging modality used to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive therapy. Aim The aim of this study was to evaluate the current status of radiofrequency ablation (RFA) treatment to evaluate the indications, techniques, complications, limitations, and outcome assessment in benign thyroid nodules in comparison with total conventional thyroidectomy. Patients and methods Twenty-four patients who underwent ultrasound-guided RFA were prospectively compared to 33 patients who underwent total thyroidectomy, between June 2017 and December 2018, and a 1-year follow-up at Ain-Shams University Hospitals. Efficacy, tolerability, and costs were compared. The contribution of the final pathology was also considered. Results There were significant differences in volume reduction in the size of the nodule after RFA during follow-up, with the initial volume of 12.41±1.63 ml decreasing to 3.61±0.5 ml after 12 months. Three (12.5%) patients showed progression in size after the 12th month. Pain, cosmetic appearance, and overall satisfaction were more acceptable in RFA than surgery. Compression symptoms and thyrotoxicosis disappeared rapidly and completely after surgery. Conclusion Surgical treatment for a solitary thyroid nodule remains the main line of treatment in view of missed malignancies by fine-needle aspiration cytology. Surgery is also more effective in abolishing thyrotoxicosis than RFA. However, for high-risk patients or those who refuse surgery, RFA is an effective alternative to surgery; it has the advantage of fewer complications and greater patient satisfaction.