Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

Issa, Peter P.; Omar, Mahmoud; Issa, Chad P.; Buti, Yusef; Hussein, Mohammad; Aboueisha, Mohamed; Abdelhady, Ali; Shama, Mohamed; Lee, Grace S.; Toraih, Eman A.; Kandil, Emad

doi:10.3390/ijms231911493

Cited by 16 publications

(11 citation statements)

References 38 publications

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“…31 Importantly, RFA almost always maintains functioning thyroid parenchyma and obviates the need for life-long hormone supplementation, with only a single report in the literature (N = 1/2421) of permanent hypothyroidism. [31][32][33] On the other hand, a previous systematic literature review and meta-analysis of ours demonstrated that rates of hypothyroidism following TL vary considerably, ranging from 10.9% to 48.8%. 34 Considering the impressive safety profile of RFA and its efficacy, consistently reducing nodular volume by 60%-100%, RFA may be another management option allowing favorable outcomes.…”

Section: Discussionmentioning

confidence: 67%

Completion thyroidectomy: A safe option for high‐volume surgeons

Issa,

Hossam,

Cheng

et al. 2023

Head & Neck

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BackgroundThe risk of complication in patients undergoing completion thyroidectomy (cT) is mixed. Several studies report increased risk in comparison to total thyroidectomy (TT) and still others reporting a comparatively decreased risk. We compared the rates of complication in patients at our institution undergoing thyroid lobectomy (TL), (TT), and cT by a single high‐volume surgeon.MethodsWe performed a single‐institution retrospective cohort study. Patients undergoing TL, TT, or cT by a high‐volume surgeon were included. Rates of complication were collected and compared between the three cohorts.ResultsA total of 310 patients were included. The overall rate of complication was 4.2%. The complication rates in the TL, TT, and cT cohorts were 1%, 7.1%, and 4.5%, respectively (p = 0.10). Transient hypocalcemia was slightly more common in the TT cohort (6.1%) as opposed to the TL (0%) or cT (0.9%) cohort (p = 0.01). The cohorts also had similar rates of recurrent laryngeal nerve signal loss leading to transient dysphonia (TL: 0% vs. TT: 1% vs. cT: 3.6%, p = 0.10).ConclusionsWhile rates of complication tended to predictably decrease as approaches became less extensive, there were no significant differences in complication rates among the three surgical approaches when performed by a high‐volume surgeon. Considering the low rates of complication overall, patient counseling and preference should be emphasized to provide appropriate and tailored treatment plans.

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Section: Discussionmentioning

confidence: 67%

Completion thyroidectomy: A safe option for high‐volume surgeons

Issa,

Hossam,

Cheng

et al. 2023

Head & Neck

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“…For patients with small PTC or both small PTC and underlying HT, minimally-invasive treatment options, such as radiofrequency ablation (RFA) may be an appropriate management option. Several works, including a prospective multi-institutional work of our own, have demonstrated RFA to be a safe and effective modality for the management of benign thyroid nodules and PTC [ 53 , 54 , 55 ]. More recently, however, RFA has been reported to be both safe and efficacious for PTC patients with HT [ 56 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Hashimoto’s Thyroiditis: A Protective Factor against Recurrence in BRAF-Wild Type Differentiated Thyroid Carcinoma

Issa

Omar

Buti

et al. 2023

Cancers

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A recent work analyzing the concomitant factors BRAF mutation (risk factor) and Hashimoto’s thyroiditis (HT) (protective factor) found that the presence of HT reduced lymph node metastasis in BRAF-mutated papillary thyroid carcinoma. Whether this notion is upheld with respect to disease recurrence and differentiated thyroid carcinoma (DTC), however, is unknown. We aimed to investigate the effect of underlying HT in DTC patients and its influence on recurrence with a specific emphasis in BRAF-mutated tumors. A total of 469 patients were included. Patients were stratified according to BRAF and HT status. Multivariate regression analysis was conducted to determine protective and risk factors of disease recurrence in patients with DTC. HT was associated with less-aggressive carcinomas including more frequent microcarcinomas (HT: 45.0% vs. no-HT: 34.0%, p = 0.02), less lymph node involvement (HT: 16.4% vs. no-HT: 26.1%, p = 0.02), and less disease recurrence (HT: 2.9% vs. no-HT: 11.9%, p = 0.002). BRAF mutation was also significantly associated with higher rates of lymph node involvement (BRAF-mutant: 41.9% vs. BRAF-wild type: 14.6%, p < 0.001) and almost two times the rate of recurrence (BRAF-mutant: 14.9% vs. BRAF-wild type: 6.5%, p = 0.004). Underlying HT was the only protective factor determined, reducing the odds of developing recurrence by 70% (HR: 0.30, 95%CI: 0.11–0.88). In the BRAF-wild type cohort, regression analysis continued to determine HT as a protective factor (p = 0.03). However, in the BRAF-mutant cohort, HT was no longer an independent protective factor (p = 0.20) against recurrence. Sub-group regression analysis, including PTC patients, similarly found HT as a protective factor only in BRAF-wild type patients (p = 0.039) and not BRAF-mutant (p = 0.627). The presence of underlying HT is associated with less aggressive tumors and is an independent protective factor against DTC recurrence, reducing the risk by 70%. HT remains a protective factor in BRAF-wild type carcinoma, but not in patients with BRAF-mutant carcinoma. HT may potentially be considered as a parameter which enhances American Thyroid Association patient risk stratification.

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“…In comparison to conventional parathyroidectomy, RFA has several advantages ( 20 ). Foremost, RFA is typically a short procedure that requires only local anesthetic.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation of an intrathyroidal parathyroid adenoma with intraoperative parathyroid hormone monitoring: a case report of a novel technique

Kandil¹,

Haidari²,

Issa³

et al. 2023

Gland Surg

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Background: Primary hyperparathyroidism (PHPT) is classically treated by conventional parathyroidectomy, an open neck surgery. Radiofrequency ablation (RFA) has been shown as a safe minimally-invasive alternative to parathyroidectomy for the management of PHPT and has been shown to be effective in 60-90% of cases. Here, we present a patient successfully treated for persistent PHPT by RFA with simultaneous intraoperative parathyroid hormone (IOPTH) monitoring. Case Description: A 51-year-old female with a past medical history of resistant hypertension, hyperlipidemia, and vitamin D deficiency presented to our endocrine surgery clinic with PHPT. Neck ultrasound (US) localized a 0.79 cm lesion suggestive of a parathyroid adenoma. Parathyroid exploration resulted in the excision of two masses. IOPTH levels dropped from 259.9 to 204.7 pg/mL. No ectopic parathyroid tissue was found. Three-month follow-up demonstrated elevated calcium levels, suggesting persistent disease. A repeat neck US one-year post operation localized a suspicious hypoechoic sub-centimeter thyroid nodule, which was subsequently determined to be an intrathyroidal parathyroid adenoma. The patient elected to proceed with RFA with IOPTH monitoring, citing concern for increased risk of redo open neck surgery. Operation pursued without complication and IOPTH levels dropped from 270 to 39.1 pg/mL. The patient's only three-day post-operative complaints, occasional numbness and tingling, were completely resolved by her three-month follow up. The patient had normal PTH and calcium levels at seven months post-operation visit and was without complaint.Conclusions: To our best knowledge, this is the first reported case of RFA with IOPTH monitoring used to manage a parathyroid adenoma. Our work adds to the growing literature suggesting minimally-invasive techniques, such as RFA with IOPTH, as a potential management option for treating parathyroid adenomas.

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Radiofrequency Ablation of Indeterminate Thyroid Nodules: The First North American Comparative Analysis

Cited by 16 publications

References 38 publications

Completion thyroidectomy: A safe option for high‐volume surgeons

Completion thyroidectomy: A safe option for high‐volume surgeons

Hashimoto’s Thyroiditis: A Protective Factor against Recurrence in BRAF-Wild Type Differentiated Thyroid Carcinoma

Radiofrequency ablation of an intrathyroidal parathyroid adenoma with intraoperative parathyroid hormone monitoring: a case report of a novel technique

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