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Efficacy and Safety of Radiofrequency Ablation of Thyroid Nodules; A Multi-institutional Prospective Cohort Study.
Jonathon O. Russell2, Mahmoud Omar1, Mohamed Aboueisha1, Abdallah S. Attia1, Samantha Wolfe2, Mohamed A. Shama1, Emad Kandil1
1Surgery, Tulane University school of medicine, Kenner, Louisiana, United States, 2Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States

Background
Radiofrequency ablation (RFA) is recently adopted to the field of thyroidology in the United States. However, it has been used as an alternative to traditional thyroid surgery in Asia and Europe since a decade. Small studies with small sample size have been published to date. We aimed to examine multi-institutional North American outcomes of benign thyroid nodules treated with RFA, as well as predictors of outcomes.

Methodology
We performed a prospective multi-institutional cohort study including patient treated with RFA between 2019 and September 2021. Demographic, nodules’ sonographic characteristics, thyroid functions, operative details, complications, and nodule measurements at 1, 3, 6, and 12 months follow up were evaluated. Adjusted multivariate logistic regression analysis was performed to identify predictors of response.

Results
A total of 233 nodules were included. The median (IQR1, IQR3) of volume reduction rate (VRR) at 1, 3, and 6 months are 57% (38-75%), 71% (46-90%), and 73% (50-87%) respectively, p value < 0.001. Two patients developed temporary hoarseness of voice. No patients developed hypothyroidism, skin burn, hematoma, or nodular rupture after the procedures. After adjusting for Age, BMI, Gender, and US features that correlated with Success of RFA (VRR >50%) after the 1st follow up is Elasticity and vascularity with Soft and low vascular had the highest OR of Success 17.4(3.2-92.9) p=0.001 follow by soft and highly vascular OR 3.9(1.1-14.2) p=0.028.

Conclusion
This is the largest North American multi-institutional study. RFA a safe and effective procedure and may be a feasible option for patients with symptomatic benign thyroid nodules while preserving thyroid function and avoiding surgical complications associated with conventional surgeries


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