Thermal and mechanical trauma exerted during moving-shot technique potential contributor to thyroid nodule rupture: JAMA

Nodule rupture is a rare but serious complication of thyroid radiofrequency ablation (RFA). With the growing adoption of thyroid RFA across the US, an understanding of thyroid nodule rupture (TNR) is crucial for recognition, management, and, ultimately, prevention. A study was done to determine procedural and patient factors that may contribute to TNR and describe experiences in managing TNR while synthesizing existing literature. This retrospective case series examined all RFA procedures for benign thyroid nodules performed by 2 attending physicians at a single academic referral centre between December 2019 and January 2024. A total of 298 consecutive patients underwent RFA for benign thyroid nodules. Criteria for offering RFA included nodules with 2 benign fine-needle aspirations, no suspicious ultrasonography features, the greatest dimension of 2 cm or greater, compressive or cosmetic concerns, and accessibility to a straight needle. The primary outcome was TNR, and measures were procedure, nodule, and patient characteristics that may have contributed to its pathogenesis. Secondary outcomes were nodule volume reduction, thyroid function, and management and sequelae of TNR. The hypothesis on the pathogenesis of TNR was formed before data collection. Results: Six of 298 patients (2%; 4 women [67%]) with a mean age of 48.5 years (range, 34-65 years) experienced TNR for a mean of 36 days postprocedure (range, 19-54 days). The mean (SD) initial nodule volume among patients with TNR was 31.45 (16.52) mL, and 3 of 6 patients (50%) underwent prior lobectomy. All ruptures were anterior. All patients were treated conservatively, and none required surgery. Five patients recovered completely; the sixth and most recent patient was healing as of the last follow-up. There are limited data on the aetiology and optimal management of TNR. These 6 cases of anterior rupture suggest that a potential contributor to TNR is thermal and mechanical trauma exerted at the fulcrum point during the moving-shot technique. The use of a smaller active tip (eg, 7 mm) and cessation of energy delivery before this point may help avoid TNR. More robust reporting of this complication may clarify risk factors for and enhance the prevention of TNR.

Reference:

Austerlitz J, Mann DS, Noel JE, Orloff LA. Thyroid Nodule Rupture Following Radiofrequency Ablation for Benign Thyroid Nodules. JAMA Otolaryngol Head Neck Surg. Published online June 13, 2024. doi:10.1001/jamaoto.2024.1400

Keywords:

Thermal, mechanical, trauma, exerted, fulcrum point, moving-shot, technique, potential, contributor, thyroid nodule rupture, JAMA, Austerlitz J, Mann DS, Noel JE, Orloff LA