Treatment of nodular goiter with compression of the neck organs in a step-by-step manner: sclerotherapy, radiofrequency ablation

As a rule, patients with a multi-nodular goiter are not regularly observed by doctors, the reason for seeking medical help is the presence of a growing formation on the neck or the development of compression syndrome. More often, such patients are referred for surgical treatment, namely for hemi- or total thyroidectomy. This study presents a clinical case of non-surgical treatment in stages using ethanol sclerase therapy and radiofrequency ablation (RFA), which allowed the organ to be preserved, while achieving the necessary cosmetic effect, there is no damage to surrounding tissues and organs. The combined treatment of diffuse nodular goiter made it possible to reduce the size of the neoplasm by 21 times from the initial one during the treatment period from 2019 to 2021, eliminated the cosmetic defect and compression syndrome. Sclerotherapy and RFA can act as an alternative to surgical methods, but without scarring of the neck. Interventional methods are effective in the treatment of thyroid nodules, including large ones.

1. WHO. Diagnosis and monitoring of diseases of the thyroid. Available from: https://iris.who.int/bitstream/handle/10665/91976/WHO_DIL_00.4_rus.pdf?sequence=1&isAllowed=y Accessed: 13.10.2023

2. Chernikov RA, Vorobjov SL, Slepzov IV, et al. Nodular goiter (epidemiology and diagnostics). Clinical and experimental thyroidology. 2013;9(2):29-35. (In Russ.) doi: https://doi.org/10.14341/ket20139229-35

3. Sung JY, Baek JH, Kim KS, Lee D, Yoo H, Kim JK, Park SH. Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation: a prospective randomized study Radiology. 2013; 269(1):293-300 doi: https://doi.org/10.1148/radiol.13122134

4. Kamran SC, Marqusee E, Kim MI, et al. Thyroid nodule size and prediction of cancer. J Clin Endocrinol Metab. 2013;98(2):564-570. doi: https://doi.org/10.1210/jc.2012-2968

5. Ushakov A.V. Klinicheskaya ul’trazvukovaya diagnostika dobrokachestven noj patologii shchitovidnoj zhelezy. Spravochnoe rukovodstvo. — M.: Klinika doktora A.V. Ushakova, 2018. — 216 s. — 84 S. (In Russ.)

6. Hegedüs L, Frasoldati A, Negro R, Papini E. European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules. Eur Thyroid J. 2020 Jul;9(4):194-204

7. Klinicheskie rekomendacii. Zabolevaniya i sostoyaniya, svyazannye s deficitom joda. — 2020. Minzdrav RF. 2021.

8. Yang CC, Hsu Y, Liou JY. Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis. Endocrinol Metab (Seoul). 2021;36(1):81-95

9. Jasim S, Patel KN, Randolph G, Adams S, Cesareo R, et al. American Association of Clinical Endocrinology Disease State Clinical Review: The Clinical Utility of Minimally Invasive Interventional Procedures in the Management of Benign and Malignant Thyroid Lesions. Endocr Pract. 2022;28(4):433-448

10. Bernet VJ, Chindris AM. Update on the Evaluation of Thyroid Nodules. J Nucl Med. 2021 Jul;62(Suppl 2):13S-19S

11. Solymosi, T. Jóindulatú pajzsmirigygöbök perkután alkoholinjekciós kezelésének hosszú távú eredményessége. 254 beteg 10 éves követésével szerzett tapasztalatok. Orvosi Hetilap OH, 2020.161(6), 224-231

12. Kuo JH, Sinclair CF, Lang B., Spiezia S., Yu M., Ha E.J., Na D.G., Offi C., Patel K.N., Baek J.H. A comprehensive review of interventional ablation techniques for the management of thyroid nodules and metast=. 2022;171(4):920-931

13. Issa PP, Cironi K, Rezvani L, Kandil E. Radiofrequency ablation of thyroid nodules: a clinical review of treatment complications. Gland Surg. 2024;13(1):77-86

14. Buyvalenko UV, Sheremeta MS, Kim IV, Trukhin AA, Korchagina MO, Sviridenko NYu. Thyroid functional autonomy — sclerotherapy and radioactive iodine therapy: case report. Endocrine Surgery. 2023;17(2):23-28. (In Russ.) doi: https://doi.org/10.14341/serg12737

15.