Manon van der Meeren1, Pim de Graaf2, Tim Boers3, Laura Deden4, Peter Veendrick4, Katya Duvivier2, Koen Dreijerink5, Sicco Braak6, Michiel Versluis7, Srirang Manohar3, Paul Cernohorsky4, Sean Roerink1, Wim Oyen4
(1) Internal Medicine, Rijnstate, Arnhem, The Netherlands.
(2) Radiology and Nuclear Medicine, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
(3) Multi-modality Medical Imaging, TechMed Center, University of Twente, Enschede, The Netherlands.
(4) Radiology and Nuclear Medicine, Rijnstate, Arnhem, The Netherlands.
(5) Endocrinology and Metabolism, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
(6) Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands.
(7) Physics of fluids group, TechMed Center, University of Twente, Enschede, The Netherlands.
Objective
Symptomatic benign thyroid nodules are frequently treated with radiofrequency ablation (RFA). Previous studies focused on evaluating the volume reduction ratio (VRR). The primary aim of this study was to assess symptom reduction after RFA. Additionally, predictive factors for VRR and the relationship between symptom reduction and VRR were evaluated.
Methods
In this multi-center prospective study, patients with benign thyroid nodules were invited to fill out adapted ThyPRO questionnaires before and after RFA and were monitored for 12 months. Patients with no (group A) or with any (group B) previous neck intervention were analyzed separately. ThyPRO goiter, appearance, composite and total scores were calculated. Dependent t-tests were used to compare scores between baseline and follow-up and to calculate effect sizes (ES, Cohen’s d). Multiple regression was used to predict VRR.
Results
In group A (n=239), all ThyPRO scores were significantly and relevantly reduced at 12 months after RFA (p<0.001, ES for goiter score 1.2). Mean VRR at 12 months was 64.8±17.6%. Results in group B (n=54) were not statistically different to group A. Baseline nodule volume and left-sided nodules predicted lower VRR (B=-0.148, <0.001, B=-10.28, p<0.001, respectively). Baseline ThyPRO goiter scores and final VRR predicted ThyPRO goiter scores at 12 months (B=-0.489, p<0.001, B=-0.189, p=0.002, respectively).
Conclusions
RFA reduces symptoms caused by thyroid nodules in both patients with and without previous neck intervention. A greater reduction in volume (VRR) is associated with more symptom reduction. Baseline nodule volume and nodule location predict VRR. Future research should include longer follow-up periods.