scholarly journals Update of Radiofrequency Ablation for Treating Benign and Malignant Thyroid Nodules. The Future Is Now

2021 ◽  
Vol 12 ◽  
Author(s):  
Ralph P. Tufano ◽  
Pia Pace-Asciak ◽  
Jonathon O. Russell ◽  
Carlos Suárez ◽  
Gregory W. Randolph ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Thyroid Nodules ◽  
Standard Of Care ◽  
Low Risk ◽  
Autonomously Functioning Thyroid Nodules ◽  
Ablative Techniques ◽  
The Right ◽  
Invasive Techniques

Thermal and chemical ablation are minimally invasive procedures that avoid removal of the thyroid gland and target symptomatic nodules directly. Internationally, Radiofrequency ablation (RFA) is among one of the most widely used thermal ablative techniques, and is gaining traction in North America. Surgery remains the standard of care for most thyroid cancer, and in the right clinical setting, Active Surveillance (AS) can be a reasonable option for low risk disease. Minimally invasive techniques have emerged as an alternative option for patients deemed high risk for surgery, or for those patients who wish to receive a more active treatment approach compared to AS. Herein, we review the literature on the safety and efficacy of RFA for treating benign non-functioning thyroid nodules, autonomously functioning thyroid nodules, primary small low risk thyroid cancer (namely papillary thyroid cancer) as well as recurrent thyroid cancer.

Technique and Procedural Aspects of Radiofrequency Ablation of Thyroid Nodules

2021 ◽  
Author(s):  
Deena Hadedeya ◽  
Abdallah S. Attia ◽  
Areej N Shihabi ◽  
Mahmoud Omar ◽  
Mohamed Shama ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Minimally Invasive ◽  
Thyroid Disease ◽  
Thyroid Nodules ◽  
Clinical Symptoms ◽  
Clinical Problem ◽  
New Novel ◽  
Number Of Patients ◽  
Technical Details ◽  
Invasive Techniques

Abstract Purpose of the Review Thyroid nodules (TNs) are a frequently seen clinical problem which increased in incidence with the usage of high-resolution ultrasound (US). Most of these nodules are benign and do not need any further management unless they start to be symptomatic, cosmetically unacceptable, or proven to be malignant. Surgery has been the only treatment option. Since scientists and clinicians became more conservative and toward minimally invasive techniques, TNs’ management was not exceptional. Minimally invasive US-guided techniques were introduced in the last two decades as a management of TNs. Radiofrequency ablation (RFA) is considered relatively the newest of all and showed a significant reduction in the size and improvement of clinical symptoms.. The aim of this article is to review basic principles and technical details of RFA. Recent Findings RFA showed promising results in TNs size reduction as well as cure of hyperthyroidism due to toxic nodules. Data also reported improvement of compressive symptoms after the procedure. Summary As RFA is a relatively new novel technique in management of thyroid disease, with further studies focusing more on indications, and outcomes, we predict that RFA will be widely applied in the management of thyroid disease. It plays a major role in reducing the number of patients undergoing surgeries and avoiding all the risk related to it.

scholarly journals Adrenal metastasis as the initial diagnosis of synchronous papillary and follicular thyroid cancer

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Xin He ◽  
Scott A. Soleimanpour ◽  
Gregory A. Clines
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Follicular Thyroid Carcinoma ◽  
Distant Metastases ◽  
Needle Aspiration ◽  
Left Lobe ◽  
Adrenal Metastasis ◽  
Bethesda Classification ◽  
The Right

Abstract Background Differentiated thyroid cancer uncommonly presents with distant metastases. Adrenal metastasis from differentiated thyroid cancer presenting as the initial finding is even less common. Case Presentation A 71-year-old male was incidentally found on chest CT to have bilateral thyroid nodules, which were confirmed on ultrasound. Fine needle aspiration of the dominant right 3.3 cm nodule contained histologic features most consistent with Bethesda classification III, and repeat fine needle aspiration revealed pathology consistent with Bethesda classification II. Follow-up thyroid ultrasound showed 1% increase and 14% increase in nodule volume at one and two years, respectively, compared to baseline. Prior to the second annual thyroid ultrasound, the patient was incidentally found to have a 4.1 cm heterogeneously enhancing mass in the right adrenal gland on CT of the abdomen and pelvis. Biochemical evaluation was unremarkable with the exception of morning cortisol of 3.2 µg/dL after dexamethasone suppression. The patient then underwent laparoscopic right adrenal gland excision, which revealed metastatic follicular thyroid carcinoma. Total thyroidectomy was then performed, with pathology showing a 4.8 cm well-differentiated follicular thyroid carcinoma of the right lobe, a 0.5 cm noninvasive follicular thyroid neoplasm with papillary-like nuclear features of the left lobe, and a 0.1 cm papillary microcarcinoma of the left lobe. Thyrotropin-stimulated whole body scan showed normal physiologic uptake of the remnant thyroid tissue without evidence of other iodine avid disease. The patient then received radioactive iodine. At follow-up 14 months after total thyroidectomy, he remains free of recurrent disease. Conclusion Despite following the recommended protocol for evaluation and surveillance of thyroid nodules, thyroid cancer can be challenging to diagnose, and may not be diagnosed until distant metastases are identified.

scholarly journals Ultrasound Assessment of Autonomous Thyroid Nodules before and after Radioiodine Therapy Using Thyroid Imaging Reporting and Data System (TIRADS)

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1038
Author(s):  
Simone Agnes Schenke ◽  
Jan Wuestemann ◽  
Michael Zimny ◽  
Michael Christoph Kreissl
Keyword(s):  
High Risk ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Diagnostic Procedures ◽  
Low Risk ◽  
Therapeutic Interventions ◽  
Thyroid Imaging ◽  
Before And After ◽  
Autonomously Functioning Thyroid Nodules ◽  
Ultrasound Assessment

The Thyroid Imaging and Reporting System (TIRADS) allows a sonographic assessment of the malignancy risk of thyroid nodules (TNs). To date, there is a lack of systematic data about the change in ultrasound (US) features after therapeutic interventions. The aim of this study was to characterize the changes in autonomously functioning thyroid nodules (AFTNs) after radioiodine therapy (RIT) by using TIRADS. We retrospectively assessed data from 68 patients with AFTNs treated with RIT between 2016 and 2018 who had available first and second follow-up US imaging. Before RIT, 69.1% of the AFTNs were classified as low-risk TNs when applying Kwak TIRADS (EU-TIRADS 52.9%), 22.1% were intermediate-risk TNs (EU-TIRADS 19.1%), and 8.8% were high-risk TNs (EU-TIRADS 27.9%). Twelve months after RIT, 22.1% of the AFTNs showed features of high-risk TNs according to Kwak TIRADS (EU-TIRADS 45.6%). The proportion of intermediate TNs also increased to 36.8% (EU-TIRADS 29.4%), and 41.2% were low-risk TNs (EU-TIRADS 25%). A significant percentage of AFTNs presented with features suspicious for malignancy according to TIRADS before RIT, and this number increased significantly after therapy. Therefore, before thyroid US, thorough anamnesis regarding prior radioiodine treatment is necessary to prevent unneeded diagnostic procedures.

Radiofrequency Ablation for Autonomously Functioning Thyroid Nodules: A Multicenter Study

Thyroid ◽  
2015 ◽  
Vol 25 (1) ◽  
pp. 112-117 ◽  
Author(s):  
Jin Yong Sung ◽  
Jung Hwan Baek ◽  
So Lyung Jung ◽  
Ji-hoon Kim ◽  
Kyu Sun Kim ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Multicenter Study ◽  
Thyroid Nodules ◽  
Autonomously Functioning Thyroid Nodules

scholarly journals Will Real Time Visualization of Needle in Target Thyroid Nodules Minimize False Negative FNA Results?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A904-A905
Author(s):  
Vijaykumar Sekar ◽  
Panadeekarn Panjawatanan ◽  
Sofia Junaid Syed
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
False Negative ◽  
Thyroid Ultrasound ◽  
Papillary Thyroid ◽  
Ultrasound Guided ◽  
Real Time Visualization ◽  
The Right

Abstract Introduction: Prevalence of thyroid nodules in the adult population based on detection by ultrasonography is about 20-76% of which only 5% account for thyroid cancer. All patients with a suspected thyroid nodule either on physical examination or noted incidentally on other imaging should be evaluated with thyroid ultrasound. Any thyroid nodule >= 1 cm on ultrasound should be investigated with FNAC. Ultrasound guided FNAC techniques are used to reduce false negative results. We present a patient with suspicious finding on initial thyroid ultrasound and subsequent negative FNAC presenting a few years later with papillary thyroid cancer. Case Presentation: A 32 y.o. female with history of thyroid nodule and thyroiditis presented to the endocrine clinic for follow-up of her thyroid nodule. 5 years ago, she was diagnosed with thyroid nodule, which was found on an ultrasound scan for workup of her dysphagia. The thyroid ultrasound then showed diffusely heterogeneous thyroid gland with an ill-defined area of decreased echogenicity in the right lobe and left superior lobe and possible nodule in the lower pole left thyroid. Blood work showed TSH of 1.71 (n 0.34-3.00 uIU/ml) and thyroid peroxidase antibody levels was 27.8 (n < 9.0 IU/ml). A CT scan of neck with contrast was done and no concerning mass was seen. The patient had a follow-up ultrasound after 8 months which showed small bilateral thyroid lesions, somewhat ill-defined. The patient had an FNA biopsy of the right thyroid nodule: the results were consistent with a benign follicular nodule. A follow-up thyroid ultrasound was done in a year, and the findings were unchanged. The patient came back 3 years later for follow-up with complaints of a new palpable nodule in the neck. Ultrasound showed unchanged right thyroid nodule and some new cervical adenopathy. The ultrasound showed a 2.2 cm heterogeneous lymph node with punctate echogenic foci along the right lateral margin of the right internal jugular vein at the level of the thyroid gland, Subsequently FNA biopsy of the right cervical node and right thyroid node were done. The cells from lymph nodes were positive for malignancy and cells from the right thyroid nodule were atypical. Overall the appearance was consistent with papillary thyroid carcinoma. Subsequently the patient underwent total thyroidectomy and right modified lymph node dissection and the pathology results came back as multifocal papillary thyroid cancer right side 1.2 cm and left side 0.4 cm, with metastasis to 2 lymph nodes. Conclusion: The reported false negative rate of ultrasound-guided FNAC is variable. Success of US-FNA depends on experience of operator and cyto-pathologist and the intrinsic nature of the nodule. Malignancy rates of only 1-2% are reported with repeat FNA in prior benign nodules. Good FNA techniques and real-time visualization of needle in target nodules can further decrease false negatives.

scholarly journals Adherence to Guideline Recommendations in Patients with Thyroid Nodules

2019 ◽  
Vol 10 (1) ◽  
pp. 1-2
Author(s):  
Rudruidee Karnchanasorn ◽  
Kristine Grdinovac ◽  
Nichole Smith ◽  
Bhairvi Jani ◽  
G. John Chen
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Clinical History ◽  
Daily Practice ◽  
Needle Aspiration ◽  
History Of ◽  
Work Up ◽  
Current Guidelines

Introduction. Thyroid nodules are common and fine-needleaspiration (FNA) biopsy is the standard of care for workupto exclude thyroid cancer. In this study, we examinedthe discrepancy between daily practice and recommendeddiagnostic approach for management of thyroid nodules,based on history taking, laboratory, and imaging studies. Methods. This was a retrospective chart review of 199 patientswho had ultrasound-guided fine needle aspiration(UGFNA) performed at a Midwest academic medicalcenter from January 2010 to December 2011. Thequality measures were selected based on recommended clinicalpractice guidelines, including family history, history of neckradiation, neck symptoms, TSH test, and thyroid ultrasound. Results. The majority of patients were Caucasian females. Familyhistory of thyroid cancer and childhood neck radiation exposurewere documented in 79 subjects (40%) and 76 subjects(38%), respectively. Neck symptoms were documented in mostsubjects, including dysphonia (56.8%), dysphagia (69.9%), anddyspnea (41.2%). Most subjects had a TSH measured and an ultrasoundperformed prior to biopsy (75% and 86%, respectively). Conclusions. It appears there is a gap between current patientcare and clinical practice guidelines for management of thyroidnodules. Clinical history and ultrasound features for risk stratificationof UGFNA were lacking, which could reflect physicians’unfamiliarity with the guidelines. As thyroid nodules are common,enhancing knowledge of the current guidelines could improveappropriate work-up. Further studies are needed to identifyfactors associated with the poor compliance with clinical guidelinesin management of thyroid nodules. KS J Med 2017;10(1):1-2.

scholarly journals Variation in medical management and neurosurgical treatment of patients with supratentorial spontaneous intracerebral haemorrhage

2021 ◽  
pp. 239698732110059
Author(s):  
Lotte Sondag ◽  
Floor AE Jacobs ◽  
Floris HBM Schreuder ◽  
Jeroen D Boogaarts ◽  
W Peter Vandertop ◽  
...  
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Intracerebral Haemorrhage ◽  
Online Survey ◽  
Treatment Decisions ◽  
Neurosurgical Treatment ◽  
The Right ◽  
Invasive Techniques ◽  
Spontaneous Intracerebral Haemorrhage

Introduction The role of surgery in spontaneous intracerebral haemorrhage (sICH) remains controversial. This leads to variation in the percentage of patients who are treated with surgery between countries. Patients and methods We sent an online survey to all neurosurgeons (n = 140) and to a sample of neurologists (n = 378) in Dutch hospitals, with questions on management in supratentorial sICH in general, and on treatment in six patients, to explore current variation in medical and neurosurgical management. We assessed patient and haemorrhage characteristics influencing treatment decisions. Results Twenty-nine (21%) neurosurgeons and 92 (24%) neurologists responded. Prior to surgery, neurosurgeons would more frequently administer platelet-transfusion in patients on clopidogrel (64% versus 13%; p = 0.000) or acetylsalicylic acid (61% versus 11%; p = 0.000) than neurologists. In the cases, neurosurgeons and neurologists were similar in their choice for surgery as initial treatment (24% and 31%; p = 0.12), however variation existed amongst physicians in specific cases. Neurosurgeons preferred craniotomy with haematoma evacuation (74%) above minimally-invasive techniques (5%). Age, Glasgow Coma Scale score and ICH location were important factors influencing decisions on treatment for neurosurgeons and neurologists. 69% of neurosurgeons and 80% of neurologists would randomise patients in a trial evaluating the effect of minimally-invasive surgery on functional outcome. Discussion Our results reflect the lack of evidence about the right treatment strategy in patients with sICH. Conclusion New high quality evidence is needed to guide treatment decisions for patients with ICH. The willingness to randomise patients into a clinical trial on minimally-invasive surgery, contributes to the feasibility of such studies in the future.

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