Ablation by RFA of a benign, normally functioning thyroid nodule: clinical and ultrasound follow-up.

11/01/2020

By Dr ROBERTO VALCAVI. November 2018. The patient introduces herself. Woman, yrs. 35. Visible left lobe thyroid nodule, causing predominantly cosmetic damage. At a prestigious Italian institution, recommended left hemithyroidectomy. Two previous aspirations at another prestigious Italian institution: Tir 2. Nodule volume about 11ml.

TSH-reflex 1.57 µU/ml (n.v. 0.25-4.40), anti-TPO antibodies <1.0 µU / ml (positive> 6), anti-Tg antibodies <1.0 µU/ml (positive> 10). Clinically euthyroid.

Repeated thyroid aspiration (3rd) at the Centro Palmer, Reggio Emilia, Italy: confirmed Thy 2. Discussed the treatment options with the patient. After accurate information the patient opts for RFA surgery.


January 2019. Radiofrequency ablation intervention (RFA) at the Centro Palmer, Reggio Emilia, Italy.

Ultrasound-guided thyroid pericapsular local anesthesia with lidocaine 2% + ropivacaine 7.5 mg / ml. Anesthesiologist: sedation with midazolam 2.5 mg i.v. + small i.v. propofol 10 mg/ml repeated boli. STARmed generator, power used 40-60 Watts. 18G monopolar RF electrode needle internally cooled by sterile saline solution at 5 ° C, length 7 cm, exposed tip 1 cm. Under continuous ultrasound control, the electrode needle is inserted into the nodular thyroid parenchyma via trans-isthmic approach. Using the "moving shot" technique, total RF thermoablation of the left thyroid nodule is completed. Delivered 6.46 kCal in an ignition time of 11'48 ". Total intervention time for field set-up and awakening of the patient: 35 min'. No side effects. Euphonic patient.


July 2019. Six months after RFA thyroid procedure

TSH-reflex 1.84 µU / ml (n.v. 0.25-4.40), anti-TPO antibodies 2.3 µU/ml (positive>6), anti-Tg antibodies 1.7 µU/ml (positive>10). Clear subjective improvement reported by the patient. At the left side ultrasonography shows the ablated thyroid nodule reduced to about 2.3 ml, hypo-echogenic at the periphery, isoechoic at the center, avascular. The nodule now falls within the thyroid gland profile. The patient is well and says she is satisfied.