Endocrine Abstracts

Background: Radiofrequency ablation (RFA) is an outpatient image-guided thermal ablation procedure that is an alternative to surgery for treating thyroid nodules. It is minimally invasive, cosmetically superior and associated with less risk of hypothyroidism.

Case: We discuss a case of 53 years old female who presented with palpitations, feeling hot, sweating, tremors, weight loss, and pins and needles. On examination, thyroid was palpable and there were no eye signs. Her investigations showed a low TSH and high FT4 and the rest of investigations, including TPO and TSI, were normal. US/S neck showed a solitary hot nodule measuring 18 mm which was hyperechoic. She was treated with carbimazole 15 mg OD and propanolol 10 mg TDS with limited benefit. She declined surgery and radioactive iodine was not an option because she had a young child. Therefore thyroid nodule RFA was performed in Turkeyafter which she became euthyroid and eventually came off carbimazole. Her post ablation scan showed decrease in size to 12 mm andnodule became isoechoic.

Discussion: The various treatment options available for autonomously functioning thyroid nodule (AFTN) are medical, surgical, radioiodine and RFA. We discuss the emerging literature surrounding the efficacy of RFA treatment, which can lead toTSH normalisation in 71.2% of patients, normalising TFTs in 45-50% of medium sized AFTN and greater than 80% of small AFTN. Whilst thyroid RFA is emerging as a safe and effective treatment for the non-surgical management of thyroid nodules, we will also discuss the recent American Thyroid Association (ATA) consensus in September 2023 that addresses the safe implementation and utilisation of the techniques.