CONTEXT: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been our main option for treatment. OBJECTIVE: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. EVIDENCE ACQUISITION: We selected recent publications related to minimally invasive thyroid techniques, with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords. MAIN FINDINGS: In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. CONCLUSIONS: Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective and can be used to treat symptomatic or enlarging thyroid masses.
CONTEXT: Nodular thyroid disease is very common. Most nodules are asymptomatic, are benign by fine-needle aspiration, remain stable, and can be followed by observation alone in the majority of the patients. Occasionally, nodules grow or cause symptoms requiring treatment. So far, surgery has been our main option for treatment. OBJECTIVE: In this review, we discuss nonsurgical, minimally invasive approaches for small thyroid masses, including indications, efficacy, side effects, and costs. EVIDENCE ACQUISITION: We selected recent publications related to minimally invasive thyroid techniques, with the focus on large-scale and preferably randomized studies, available via PubMed search in authors' files, using appropriate searches and keywords. MAIN FINDINGS: In large centers with experienced hands, minimally invasive approaches appear effective and safe. At present, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Either ultrasound-guided laser or radiofrequency ablation can be used for symptomatic solid nodules with normal or abnormal thyroid function. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. These techniques have also been applied to recurrent locoregional cervical thyroid cancer with encouraging initial results, although still limited data. CONCLUSIONS: Surgery and radioiodine remain as conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective and can be used to treat symptomatic or enlarging thyroid masses.
Authors: Harald Dobnig; Wolfgang Zechmann; Michael Hermann; Michael Lehner; Dirk Heute; Siroos Mirzaei; Alois Gessl; Vinzenz Stepan; Günter Höfle; Philipp Riss; Andrea Simon Journal: Wien Med Wochenschr Date: 2019-02-06
Authors: Anna Pisani Mainini; Cristian Monaco; Lorenzo Carlo Pescatori; Chiara De Angelis; Francesco Sardanelli; Luca Maria Sconfienza; Giovanni Mauri Journal: J Ultrasound Date: 2016-10-21
Authors: Giovanni Mauri; Laszlo Hegedüs; Steven Bandula; Roberto Luigi Cazzato; Agnieszka Czarniecka; Oliver Dudeck; Laura Fugazzola; Romana Netea-Maier; Gilles Russ; Göran Wallin; Enrico Papini Journal: Eur Thyroid J Date: 2021-05-25