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Ablation therapies for thyroid nodules and parathyroid adenomas: What we should know?

Year 2025, Volume: 2 Issue: 1, 1 - 8, 15.02.2025
https://doi.org/10.70058/cjm.1516530

Abstract

Thyroid nodules and parathyroid adenomas are common endocrine disorders that can lead to significant clinical symptoms and necessitate intervention. Traditionally, surgical resection has been the primary treatment for symptomatic or malignant thyroid nodules and parathyroid adenomas. However, surgery carries risks such as hypothyroidism, nerve damage and postoperative complications and may not be suitable for patients, especially those with comorbidities. Recently, non-surgical, image-guided ablation therapies, including ethanol ablation (EA), radiofrequency ablation (RFA), and microwave ablation (MWA), have emerged as viable alternatives for managing benign symptomatic thyroid nodules and parathyroid adenomas. This review highlights the indications, techniques, and outcomes associated with these ablative therapies. While the use of thermal ablation in managing thyroid nodules is well-supported by various guidelines, its application in parathyroid adenomas remains exploratory. The safety and efficacy profiles of these minimally invasive treatments make them promising alternatives to surgery, especially for patients who are high-risk surgical candidates or prefer non-surgical options.

References

  • Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6):901-911. doi:10.1016/j. beem.2008.09.019
  • Genere N, El Kawkgi OM, Giblon RE, et al. Incidence of Clinically Relevant Thyroid Cancers Remains Stable for Almost a Century: A Population-Based Study. Mayo Clin Proc. 2021;96(11):2823- 2830. doi:10.1016/j.mayocp.2021.04.028
  • Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA. 2015;313(9):926-935. doi:10.1001/jama.2015.0956
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393(5):667-673. doi:10.1007/s00423-008-0366-7
  • Sung JY, Baek JH, Kim KS, Lee D, Ha EJ, Lee JH. Symptomatic nonfunctioning parathyroid cysts: role of simple aspiration and ethanol ablation. Eur J Radiol. 2013;82(2):316-320. doi:10.1016/j.ejrad.2012.10.009
  • Korkusuz H, Wolf T, Grünwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia. 2018;34(5):639-643. doi:10 .1080/02656736.2018.1453552
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Kim BM, Kim MJ, Kim EK, Park SI, Park CS, Chung WY. Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol. 2008;18(4):835-842. doi:10.1007/s00330-007-0809-5
  • Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178(3):699-704. doi:10.2214/ajr.178.3.1780699
  • Bennedbaek FN, Karstrup S, Hegedüs L. Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases. Eur J Endocrinol. 1997;136(3):240-250. doi:10.1530/ eje.0.1360240
  • Bennedbaek FN, Hegedüs L. Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab. 2003;88(12):5773-5777. doi:10.1210/ jc.2003-031000.
  • Jang SW, Baek JH, Kim JK, et al. How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol. 2012;81(5):905- 910. doi:10.1016/j.ejrad.2011.02.039
  • Guglielmi R, Pacella CM, Bianchini A, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid. 2004;14(2):125-131. doi:10.1089/105072504322880364
  • Monzani F, Goletti O, Caraccio N, et al. Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation. Clin Endocrinol (Oxf). 1992;36(5):491- 497. doi:10.1111/j.1365-2265.1992.tb02251.x
  • Mazzeo S, Toni MG, De Gaudio C, et al. Percutaneous injection of ethanol to treat autonomous thyroid nodules. AJR Am J Roentgenol. 1993;161(4):871-876. doi:10.2214/ajr.161.4.8372778
  • Di Lelio A, Rivolta M, Casati M, Capra M. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection. AJR Am J Roentgenol. 1995;164(1):207-213. doi:10.2214/ajr.164.1.7998541
  • Suh CH, Baek JH, Choi YJ, Lee JH. Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta- Analysis. Thyroid. 2016;26(3):420-428. doi:10.1089/ thy.2015.0545
  • Kim YJ, Baek JH, Ha EJ, et al. Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors. Eur Radiol. 2012;22(7):1573-1578. doi:10.1007/ s00330-012-2406-5
  • Kim DW, Rho MH, Kim HJ, Kwon JS, Sung YS, Lee SW. Percutaneous ethanol injection for benign cystic thyroid nodules: is aspiration of ethanol-mixed fluid advantageous?. AJNR Am J Neuroradiol. 2005;26(8):2122-2127.
  • Larson TR, Bostwick DG, Corica A. Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia. Urology. 1996;47(4):463-469. doi:10.1016/S0090- 4295(99)80478-6
  • Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol. 2010;21(8 Suppl):S179-S186. doi:10.1016/j.jvir.2010.04.008
  • Liu YJ, Qian LX, Liu D, Zhao JF. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Exp Biol Med (Maywood). 2017;242(15):1515-1523. doi:10.1177/1535370217727477 24.
  • Zheng BW, Wang JF, Ju JX, Wu T, Tong G, Ren J. Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Endocrine. 2018;62(2):307-317. doi:10.1007/ s12020-018-1693-2
  • Qian Y, Li Z, Fan C, Huang Y. Comparison of ultrasound-guided microwave ablation, laser ablation, and radiofrequency ablation for the treatment of elderly patients with benign thyroid nodules: A meta-analysis. Exp Gerontol. 2024;191:112425. doi:10.1016/j. exger.2024.112425
  • Kim JH, Baek JH, Lim HK, et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018;19(4):632-655. doi:10.3348/kjr.2018.19.4.632
  • Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J. 2020;9(4):172-185. doi:10.1159/000508484
  • Mauri G, Hegedüs L, Bandula S, et al. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J. 2021;10(3):185-197. doi:10.1159/000516469
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Khandelwal AH, Batra S, Jajodia S, et al. Radiofrequency Ablation of Parathyroid Adenomas: Safety and Efficacy in a Study of 10 Patients. Indian J Endocrinol Metab. 2020;24(6):543-550. doi:10.4103/ijem.IJEM_671_20
  • Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia. 2017;33(8):920-930. doi:10.1080/02656736.201 7.1337936
  • Cui T, Jin C, Jiao D, Teng D, Sui G. Safety and efficacy of microwave ablation for benign thyroid nodules and papillary thyroid microcarcinomas: A systematic review and metaanalysis. Eur J Radiol. 2019;118:58-64. doi:10.1016/j. ejrad.2019.06.027
  • Chung SR, Baek JH, Sung JY, Ryu JH, Jung SL. Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features. Endocrinol Metab (Seoul). 2019;34(4):415-421. doi:10.3803/EnM.2019.34.4.415

Tiroid nodülleri ve paratiroid adenomlarında ablasyon tedavileri: Bilmemiz gerekenler nelerdir?

Year 2025, Volume: 2 Issue: 1, 1 - 8, 15.02.2025
https://doi.org/10.70058/cjm.1516530

Abstract

References

  • Dean DS, Gharib H. Epidemiology of thyroid nodules. Best Pract Res Clin Endocrinol Metab. 2008;22(6):901-911. doi:10.1016/j. beem.2008.09.019
  • Genere N, El Kawkgi OM, Giblon RE, et al. Incidence of Clinically Relevant Thyroid Cancers Remains Stable for Almost a Century: A Population-Based Study. Mayo Clin Proc. 2021;96(11):2823- 2830. doi:10.1016/j.mayocp.2021.04.028
  • Durante C, Costante G, Lucisano G, et al. The natural history of benign thyroid nodules. JAMA. 2015;313(9):926-935. doi:10.1001/jama.2015.0956
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Bergenfelz A, Jansson S, Kristoffersson A, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393(5):667-673. doi:10.1007/s00423-008-0366-7
  • Sung JY, Baek JH, Kim KS, Lee D, Ha EJ, Lee JH. Symptomatic nonfunctioning parathyroid cysts: role of simple aspiration and ethanol ablation. Eur J Radiol. 2013;82(2):316-320. doi:10.1016/j.ejrad.2012.10.009
  • Korkusuz H, Wolf T, Grünwald F. Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation. Int J Hyperthermia. 2018;34(5):639-643. doi:10 .1080/02656736.2018.1453552
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Kim BM, Kim MJ, Kim EK, Park SI, Park CS, Chung WY. Controlling recurrent papillary thyroid carcinoma in the neck by ultrasonography-guided percutaneous ethanol injection. Eur Radiol. 2008;18(4):835-842. doi:10.1007/s00330-007-0809-5
  • Lewis BD, Hay ID, Charboneau JW, McIver B, Reading CC, Goellner JR. Percutaneous ethanol injection for treatment of cervical lymph node metastases in patients with papillary thyroid carcinoma. AJR Am J Roentgenol. 2002;178(3):699-704. doi:10.2214/ajr.178.3.1780699
  • Bennedbaek FN, Karstrup S, Hegedüs L. Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases. Eur J Endocrinol. 1997;136(3):240-250. doi:10.1530/ eje.0.1360240
  • Bennedbaek FN, Hegedüs L. Treatment of recurrent thyroid cysts with ethanol: a randomized double-blind controlled trial. J Clin Endocrinol Metab. 2003;88(12):5773-5777. doi:10.1210/ jc.2003-031000.
  • Jang SW, Baek JH, Kim JK, et al. How to manage the patients with unsatisfactory results after ethanol ablation for thyroid nodules: role of radiofrequency ablation. Eur J Radiol. 2012;81(5):905- 910. doi:10.1016/j.ejrad.2011.02.039
  • Guglielmi R, Pacella CM, Bianchini A, et al. Percutaneous ethanol injection treatment in benign thyroid lesions: role and efficacy. Thyroid. 2004;14(2):125-131. doi:10.1089/105072504322880364
  • Monzani F, Goletti O, Caraccio N, et al. Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation. Clin Endocrinol (Oxf). 1992;36(5):491- 497. doi:10.1111/j.1365-2265.1992.tb02251.x
  • Mazzeo S, Toni MG, De Gaudio C, et al. Percutaneous injection of ethanol to treat autonomous thyroid nodules. AJR Am J Roentgenol. 1993;161(4):871-876. doi:10.2214/ajr.161.4.8372778
  • Di Lelio A, Rivolta M, Casati M, Capra M. Treatment of autonomous thyroid nodules: value of percutaneous ethanol injection. AJR Am J Roentgenol. 1995;164(1):207-213. doi:10.2214/ajr.164.1.7998541
  • Suh CH, Baek JH, Choi YJ, Lee JH. Efficacy and Safety of Radiofrequency and Ethanol Ablation for Treating Locally Recurrent Thyroid Cancer: A Systematic Review and Meta- Analysis. Thyroid. 2016;26(3):420-428. doi:10.1089/ thy.2015.0545
  • Kim YJ, Baek JH, Ha EJ, et al. Cystic versus predominantly cystic thyroid nodules: efficacy of ethanol ablation and analysis of related factors. Eur Radiol. 2012;22(7):1573-1578. doi:10.1007/ s00330-012-2406-5
  • Kim DW, Rho MH, Kim HJ, Kwon JS, Sung YS, Lee SW. Percutaneous ethanol injection for benign cystic thyroid nodules: is aspiration of ethanol-mixed fluid advantageous?. AJNR Am J Neuroradiol. 2005;26(8):2122-2127.
  • Larson TR, Bostwick DG, Corica A. Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia. Urology. 1996;47(4):463-469. doi:10.1016/S0090- 4295(99)80478-6
  • Hong K, Georgiades C. Radiofrequency ablation: mechanism of action and devices. J Vasc Interv Radiol. 2010;21(8 Suppl):S179-S186. doi:10.1016/j.jvir.2010.04.008
  • Liu YJ, Qian LX, Liu D, Zhao JF. Ultrasound-guided microwave ablation in the treatment of benign thyroid nodules in 435 patients. Exp Biol Med (Maywood). 2017;242(15):1515-1523. doi:10.1177/1535370217727477 24.
  • Zheng BW, Wang JF, Ju JX, Wu T, Tong G, Ren J. Efficacy and safety of cooled and uncooled microwave ablation for the treatment of benign thyroid nodules: a systematic review and meta-analysis. Endocrine. 2018;62(2):307-317. doi:10.1007/ s12020-018-1693-2
  • Qian Y, Li Z, Fan C, Huang Y. Comparison of ultrasound-guided microwave ablation, laser ablation, and radiofrequency ablation for the treatment of elderly patients with benign thyroid nodules: A meta-analysis. Exp Gerontol. 2024;191:112425. doi:10.1016/j. exger.2024.112425
  • Kim JH, Baek JH, Lim HK, et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018;19(4):632-655. doi:10.3348/kjr.2018.19.4.632
  • Papini E, Monpeyssen H, Frasoldati A, Hegedüs L. 2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules. Eur Thyroid J. 2020;9(4):172-185. doi:10.1159/000508484
  • Mauri G, Hegedüs L, Bandula S, et al. European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions. Eur Thyroid J. 2021;10(3):185-197. doi:10.1159/000516469
  • Haugen BR, Alexander EK, Bible KC, et al. 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. 2016;26(1):1-133. doi:10.1089/thy.2015.0020
  • Khandelwal AH, Batra S, Jajodia S, et al. Radiofrequency Ablation of Parathyroid Adenomas: Safety and Efficacy in a Study of 10 Patients. Indian J Endocrinol Metab. 2020;24(6):543-550. doi:10.4103/ijem.IJEM_671_20
  • Chung SR, Suh CH, Baek JH, Park HS, Choi YJ, Lee JH. Safety of radiofrequency ablation of benign thyroid nodules and recurrent thyroid cancers: a systematic review and meta-analysis. Int J Hyperthermia. 2017;33(8):920-930. doi:10.1080/02656736.201 7.1337936
  • Cui T, Jin C, Jiao D, Teng D, Sui G. Safety and efficacy of microwave ablation for benign thyroid nodules and papillary thyroid microcarcinomas: A systematic review and metaanalysis. Eur J Radiol. 2019;118:58-64. doi:10.1016/j. ejrad.2019.06.027
  • Chung SR, Baek JH, Sung JY, Ryu JH, Jung SL. Revisiting Rupture of Benign Thyroid Nodules after Radiofrequency Ablation: Various Types and Imaging Features. Endocrinol Metab (Seoul). 2019;34(4):415-421. doi:10.3803/EnM.2019.34.4.415
There are 33 citations in total.

Details

Primary Language English
Subjects Radiology and Organ Imaging
Journal Section Reviews
Authors

Tümay Bekci 0000-0002-3147-2786

Uluhan Eryürük 0000-0001-6581-621X

Publication Date February 15, 2025
Submission Date August 20, 2024
Acceptance Date September 17, 2024
Published in Issue Year 2025 Volume: 2 Issue: 1

Cite

Vancouver Bekci T, Eryürük U. Ablation therapies for thyroid nodules and parathyroid adenomas: What we should know?. Cerasus J Med. 2025;2(1):1-8.