Novel Approaches for Treating Autonomously Functioning Thyroid Nodules

Abstract

Benign thyroid nodules are exceedingly common in the adult population. Only a small percentage of nodules are toxic or autonomously functioning thyroid nodules (AFTNs). The options clinicians have for treating the symptoms of hyperthyroidism include anti-thyroidal medications, radioactive iodine, or surgery. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient. On the other hand, untreated hyperthyroidism can lead to osteoporosis, atrial fibrillation, emotional lability, and neurological consequences. Thus, we present a review of two novel safe and effective approaches for treating AFTN; one surgical (transoral endoscopic thyroid surgery) and one non-surgical (radiofrequency ablation), as a means for expanding our treatment armamentarium.

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

“…No studies from the U.S. investigate the cost effectiveness of RFA of toxic thyroid nodules. Depending on the patient population treated, these options may not be suitable or have inherent risks that are undesirable to the patient, suggesting RFA to be a potentially safe and effective approach for treating AFTNs ( Figure 4 ) ( 36 ).…”

2022 Taiwan clinical multicenter expert consensus and recommendations for thyroid radiofrequency ablation

“…In instances of AFTN, RFA has been suggested as a viable alternative treatment [7,8,36,61,62,[66][67][68][69]. Indications of treatment for patients with AFTN include cases with symptoms of hyperthyroidism, symptoms of compression, and cosmetic concerns [61].…”

Radiofrequency ablation and related ultrasound‐guided ablation technologies for treatment of benign and malignant thyroid disease: An international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology,

“…Like with surgery, successful treatment of functional nodules involves achievement of a euthyroid state without antithyroid drugs or thyroid hormone replacement 144 . Persistent hyperthyroidism resulting from inadequate treatment is associated with long‐term cardiovascular and skeletal morbidity and even mortality in older adults 145,146 .…”