Radiofrequency or microwave ablation vs surgery for treatment of benign non-toxic, toxic nodules, and toxic diffuse autoimmune hyperthyroidism

Abstract Introduction Thermal ablation (TA) techniques have gained widespread use in the treatment of benign thyroid nodules. Clinical studies have demonstrated that TA significantly reduces the volume of thyroid nodules. While TA has proven to be a safe and effective treatment option for benign and toxic thyroid conditions, it is not without risks. We performed a health technology assessment (HTA) analysis of TA vs surgery for 1) benign non-toxic nodules 2) toxic nodules and 3) Graves'. Method PICO (P- Population, I - Intervention, C - Comparators, O - Outcomes) was defined. P1: patients with benign non-toxic nodules, P2 - patients with toxic nodules, P3 - patients with Graves´. I - TA. C - Surgery. O - Critical for decision making: symptom change, complications, recurrence, re-intervention, malignancy and mortality. Important for decision making: time consumption, volume reduction, biochemical response. Literature search included the following types of studies: RCTs, non-randomized controlled studies and case series. Result The HTA analysis will be finalized by June 2025. Four RCTs and 14 cohort studies were included. TA in adults with benign or toxic thyroid nodules was associated with a reduction in nodule volume by 65-93% and a reduced operation time, length of hospital stay, and need for hormone replacement therapy when compared with conventional surgery. In addition, we found that TA may result in improvement in HRQoL and improved biochemical response. However, it is uncertain if TA is associated with any difference in complications, malignancy or re-intervention. Discussion In conclusion, TA may be an alternative to conventional surgery for select patients with benign non-toxic or toxic disease.