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 Apr;28(4):433-448. doi: 10.1016/j.eprac.2022.02.011.

Abstract

Objective: The objective of this disease state clinical review is to provide clinicians with a summary of the nonsurgical, minimally invasive approaches to managing thyroid nodules/malignancy, including their indications, efficacy, side effects, and outcomes.

Methods: A literature search was conducted using PubMed and appropriate key words. Relevant publications on minimally invasive thyroid techniques were used to create this clinical review.

Results: Minimally invasive thyroid techniques are effective and safe when performed by experienced centers. To date, percutaneous ethanol injection therapy is recommended for recurrent benign thyroid cysts. Both ultrasound-guided laser and radiofrequency ablation can be safely used for symptomatic solid nodules, both toxic and nontoxic. Microwave ablation and high-intensity focused ultrasound are newer approaches that need further clinical evaluation. Despite limited data, encouraging results suggest that minimally invasive techniques can also be used in small-size primary and locally recurrent thyroid cancer.

Conclusion: Surgery and radioiodine treatment remain the conventional and established treatments for nodular goiters. However, the new image-guided minimally invasive approaches appear safe and effective alternatives when used appropriately and by trained professionals to treat symptomatic or enlarging thyroid masses.

Keywords: ethanol; radiofrequency; thermal ablation; thyroid cancer; thyroid nodule.

Publication types

  • Review

MeSH terms

  • Catheter Ablation* / methods
  • Humans
  • Iodine Radioisotopes / therapeutic use
  • Neoplasm Recurrence, Local / surgery
  • Thyroid Neoplasms* / surgery
  • Thyroid Nodule* / pathology
  • Thyroid Nodule* / surgery
  • Treatment Outcome

Substances

  • Iodine Radioisotopes