Study of the Feasibility of Radiofrequency Ablation of Benign Thyroid Nodules

Study of the Feasibility of Radiofrequency Ablation of Benign Thyroid Nodules by Percutaneous Radiological Approach

The purpose of the present protocol is to evaluate the response rate to treatment of these symptomatic benign nodules with radiofrequency as an alternative to surgical treatment.

This thyroid nodules ablation with radiofrequency will be directed by a single percutaneous procedure guided by ultrasound. The procedure includes an ultrasound with percutaneously radiofrequency ablation of benign thyroid nodule. Clinical and ultrasonographic monitoring will last a year with consultations at 2 weeks (consultation only), 3 months, 6 months and 1 year (consultation, ultrasound TSH). The success of this procedure will be controlled with 3 successive ultrasounds the following year. The expected results are a decrease in the size of the nodule by at least 50% and a reduction in the functional and aesthetic discomfort, with less frequent complication than what is expected with surgery. The present study also intends to determine the medico economic impact of this technique compared to surgery.

Thyroid benign nodules represent a major public health problem because they are very common (subclinical nodules were found in half of woman beyond 60 years). The main risk factors include age, female gender, parity, smoking and family history of thyroid nodules or thyroiditis. The assessment is based on biology, ultrasound and fine needle aspiration and intends to determine the benign nature (95%) or cancer (5%) of the nodules and if they are functional or not (toxic nodule). Most benign nodules are asymptomatic but some of them because of their size and location can cause a functional disorder (compression or swallowing disorder) or aesthetic and psychological resounding.In current practice, these nodules are sometimes treated with surgery that impact on patient quality of life (need to take L-Thyroxine, difficulties related to the possible occurrence of complications like hypoparathyroidism or laryngeal paralysis) and socio-economic constraints especially when complications occur. To limit the number of unnecessary and potentially risky surgeries, patients should therefore be well selected. If surgery is the preferred treatment of thyroid cancer, alternative techniques like radiofrequency seem interesting for benign nodules.

Inclusion Criteria:

• Euthyroid or hypothyroidism properly substituted with normal TSH
• Benin nodule proved by FNA (Bethesda) and normal Calcitonin
• Nodule size> 1cm and / or increase in size
• Single nodule or asymptomatic nodules associated
• Symptomatic nodule with functional impairment and / or aesthetic Patient Agreement
• Patient with insurance coverage
• Written agreement for participation

Exclusion Criteria:

The exclusion criteria are related to the histological nature of the nodule and the necessary of the procedure:

• Allergy to local anesthetics
• FNA non-contributory or suspicious nodule (Bethesda)
• Multiple nodules more than 2cm
• Hyperthyroidism or hyperparathyroidism associated requiring surgical intervention.
• Taking a treatment with anticoagulant or double antiplatelet
• Patient with a Pacemaker
• Contralateral laryngeal paralysis in nodule
• Purely cystic nodule
• Nodule in contact with the recurrent nerve
• Patient Refusal
• Pregnant and breastfeeding women
• Patient trust, guardianship or safeguard justice.