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Efficacy of single-session radiofrequency ablation (RFA) in rendering euthyroidism for persistent/relapsed Graves’ disease, a pilot study

  • Interventional
  • Published:
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Abstract

Objectives

Graves’ disease (GD) is the most common cause of hyperthyroidism. Antithyroid drug (ATD) is often the first-line treatment but  > 50% patients suffer a relapse when ATD is discontinued. Surgery or radioiodine remains the current options of definitive treatment in these patients. This pilot study examined the short-term efficacy of single-session thyroid radiofrequency ablation (RFA) as a novel definitive treatment for persistent/relapsed GD.

Methods

Consecutive patients with persistent/relapsed GD requiring ATD were considered. Those with a clear surgical indication, either thyroid lobe volume  ≥ 20 mL; those who were pregnant or lactating; and those who had any severe medical conditions that would pose extra treatment risks were excluded. Eligible patients received ultrasound-guided RFA of the entire bulk of thyroid gland. Thyroid function tests were monitored bi-monthly. The primary outcome was disease remission rate, defined as a state of biochemical euthyroidism or hypothyroidism without ATD. Secondary outcomes were complication rates.

Results

Of the 68 patients considered, 15 (22.1%) patients were eligible. Most were females (93.3%). The median age was 37 (IQR 31–48) years old. The disease remission rates were 79.0% at 6 months and 73.3% at 12 months. Among the 4 patients who relapsed after RFA, three required less ATD dose than before RFA. RFA was well-tolerated in the ambulatory setting. There were no vocal cord palsy, skin burn, hematoma, or thyroid storm after RFA.

Conclusions

In well-selected patients, single-session RFA of the thyroid gland may be a potential treatment for patients with persistent/relapsed GD. It is a safe and well-tolerated ambulatory procedure.

Key Points

• Radiofrequency ablation of the thyroid gland is an efficacious treatment for persistent/relapsed Graves’ disease in well-selected patients.

• Radiofrequency ablation of the thyroid gland for the treatment of persistent/relapsed Graves’ disease is a safe and well-tolerated ambulatory procedure.

• Radiofrequency ablation of the thyroid gland may be a potential alternative treatment for well-selected patients with persistent/relapsed GD who do not wish to undergo either thyroidectomy or radioactive iodine or continue antithyroid drugs.

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Abbreviations

AntiTSHR:

Anti-thyroid stimulating hormone receptor antibody

ATD:

Antithyroid drug

FNAC:

Fine needle aspiration cytology

GD:

Graves’ disease

GO:

Graves’ ophthalmopathy

HIFU:

High-intensity focused-ultrasound

LUSG:

Laryngeal ultrasonography

RAI:

Radioiodine therapy

RFA:

Radiofrequency ablation

TSH:

Thyroid-stimulating hormone

USG:

Ultrasonography

VCP:

Vocal cord palsy

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Surgery, Division of Endocrine Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China

    Man Him Matrix Fung & Brian Hung Hin Lang

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  1. Man Him Matrix Fung
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  2. Brian Hung Hin Lang
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Correspondence to Brian Hung Hin Lang.

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The scientific guarantor of this publication is Professor Brian Lang.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all subjects (patients) in this study.

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Fung, M.H.M., Lang, B.H.H. Efficacy of single-session radiofrequency ablation (RFA) in rendering euthyroidism for persistent/relapsed Graves’ disease, a pilot study. Eur Radiol 33, 6534–6544 (2023). https://doi.org/10.1007/s00330-023-09620-1

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