Minimal Invasive Procedures for the Treatment of Thyroid Nodules

Background: Thyroid nodules (TNs) are frequently encountered in routine ultrasound imaging of the healthy adult population. While the majority of TNs are benign, they carry varying degrees of malignancy risk. The primary method used to obtain tissue diagnosis percutaneously is fine-needle aspiration biopsy (FNAB). Another method is core needle biopsy. Due to the risks associated with surgical intervention, minimally invasive procedures performed under imaging guidance have gained popularity in recent years. These include percutaneous treatments (simple aspiration, ethanol injection, and ablation) and thyroid artery embolization (TAE). Procedures are performed in an ambulatory setting under local anesthesia. Their efficacy has been demonstrated in symptomatic or autonomously functioning benign TNs. While there is currently insufficient evidence for the treatment of primary or recurrent papillary thyroid cancer, these methods are employed in specific cases. In cystic and predominantly cystic thyroid nodules (TN), the drainage of fluid content is achieved through simple aspiration. Percutaneous Ethanol Injection (PEI) is the primary method for treating recurrent TNs following aspiration. Thermal Ablation (TA) aims to induce heat-mediated coagulation necrosis in the target tissue using nonionizing electromagnetic energy. Laser, radiofrequency, and microwave ablation are types of TA methods. TAE involves embolization of thyroid arteries, primarily aiming for a reduction in TN size.

Educational Points: Minimally invasive procedures have become an alternative to surgery in the diagnosis and treatment of TN in recent years, mainly due to their good tolerability, ease of use and low complication rate. Ablations and embolizations have been used for benign TN for some time and have recently been used in selected cases of thyroid malignancies. This presentation will elaborate on minimal invasive procedures for the treatment of TN will be explained in more detail.

Publication History

Article published online:
02 April 2024