Minimally invasive treatments for thyroid nodules

Abstract

The incidence of thyroid nodules, either solitary or within a multinodular goiter, is steadily increasing during the last decades, and new therapeutic tools, besides the current options of simple surveillance or surgery, would be profitable to attain a personalized management. Most thyroid nodules are asymptomatic and benign at cytological assessment, remain stable over the years, and do not warrant treatment. In other cases, however, the nodules grow progressively, become visible, and eventually cause local symptoms. As in these cases, a protracted clinical observation is frequently followed by surgical consultation; a well-timed use of minimally invasive procedures could reshape the progression of these benign thyroid lesions toward surgery. Percutaneous ethanol injection may be considered as the first-line treatment for recurrent benign cystic lesions, while in nonfunctioning nodules, thermal ablation techniques performed with laser or radiofrequency provide significant shrinkage and improvement of pressure symptoms. HIFU, a noninvasive treatment based on the use of high-intensity ultrasound waves, is a promising but not yet fully evaluated procedure. Finally, the ablation with microwaves should still be considered as an experimental technique for thyroid lesions. Minimally invasive procedures should be used for hyperfunctioning lesions only when radioisotope treatment or surgery is contraindicated or not available. Both percutaneous ethanol injection and thermal ablation procedures are performed on outpatients, carry a very low risk of complications, and do not result in thyroid function abnormalities. Before treatment the risk of malignancy should be excluded with repeat cytological assessment, and a thyroid ultrasound follow-up is prudent after ablation treatment.