Authors (including presenting author) :
Lee KFA (1), Yeung WCZ (1), Lau HLE(2), Chan YKJ (3)
Affiliation :
(1) Otorrhinolaryngology, Head and Neck Surgery, Tseung Kwan O Hospital
(2) Otorrhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital
(3) Otorrhinolaryngology, The Chinese University of Hong Kong
Introduction :
Benign thyroid nodules are a common pathology presenting to ENT, found in 50-60% of the adult population with 10-15% being symptomatic. They are conventionally treated with hemithyroidectomy, which despite its advantages of obtaining histology and complete removal can be distressing to the patient due to general anaesthesia, unsightly scarring and potential debilitating surgical complications such as recurrent laryngeal nerve palsy and hypothyroidism. In addition, they can be a heavy burden to the healthcare provider due to the large number of cases, cost of surgery and long waiting time for operating theatre lights.
Radiofrequency ablation is a local anaesthetic procedure that uses high-alternating current to destroy tissues with heat. It has been increasingly used in Europe and Korea for the treatment of benign thyroid nodules.
Objectives :
To evaluate the safety and effectiveness of radiofrequency ablation (RFA) for benign thyroid nodules by ENT surgeons and to compare it to conventional hemithyroidectomy.
Methodology :
50 patients who underwent a single session of RFA for symptomatic benign thyroid nodules in Prince of Wales Hospital and Tseung Kwan O Hospital in Hong Kong from 2020-2022 were evaluated. All cases were operated under local anaesthesia as day cases.
Objective outcomes including nodule volume, volume reduction rate and complications were recorded. Subjective response in the form of a 0–10-point scale for patient symptoms, including: obstructive, cosmetic, pain and satisfaction scores were also collected.
We then compared them with a historical cohort of hemithyroidectomy patients from 2017-2021 from the same two centres, matched for number, age, volume and gender. Variables compared between the 2 groups included: duration of procedure, cost to patient and complication rate.
Result & Outcome :
Significant reduction in mean volume reduction rate (VRR)was found at 3 months (61.3%, p< 0.001), 6 months (69.1%, p< 0.001) and 1 year (76.7%, p< 0.001) post treatment for the RFA patients. While not significant due to small sample size, the mean VRR at 2 years follow up was 84.6%. This was accompanied by a significant reduction in both the mean patient compressive and cosmetic symptom score, dropping from 4 out of 10 to less than 1 out of 10 at 6 months and 1 year (p< 0.001).
Comparing with conventional hemithyroidectomy, the RFA group had a significantly shorter mean procedure time at 43 minutes compared to 112 minutes (p< 0.001). The RFA group also had a significantly lower rate of complications (8%) compared with the hemithyroidectomy group (37.1%), p< 0.05. None of the patients from the RFA group developed visible scars or needle marks post treatment whilst 5.7% of the hemithyroidectomy patients had scar related complications. Estimated cost to patient for RFA was found to be less than half of that of hemithyroidectomy, at 29,008 HKD compared to 73,917 HKD respectively.
RFA is a safe and effective form of treatment for benign thyroid nodules. Our data suggests that compared to conventional hemithyroidectomy, it has advantages of being a scarless local anaesthetic procedure with shorter procedure time, lower complication rate and lower cost to patient.
