Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

Abstract

Background: Thyroid nodules are common clinical findings. Although there are various accepted treatments for benign thyroid nodules, such as surgery and thermal treatment, there are some alternative methods for the management of these patients at lower costs with minimal complications. Objectives: This study aimed to compare volume reduction in radiofrequency (RF) ablation and single-session ethanol ablation (EA) and to investigate the effects of levothyroxine therapy (LT4) on benign thyroid nodules. Patients and Methods: In this clinical trial, 91 patients with benign thyroid nodules, presenting to different medical centers in Tehran, Iran, from December 6, 2018, to December 6, 2019, were included. Patients who met the inclusion criteria were selected and randomly allocated into three groups: group 1, a single session of RF ablation (n = 31); group 2, a single session of ethanol injection (n = 30); and group 3, a six-month LT4 treatment (n = 30). Thyroid tests, including thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), anti-thyroid peroxidase (anti-TPO), T3 resin uptake (T3RU), and serum calcitonin level, were recorded at baseline and within one-, three-, and six-month intervals. The nodule volume was also assessed using sonography at baseline and in the follow-ups. Results: The mean volume reduction was 73.6%, 80.1%, and 8.7% at six months after the intervention in the ethanol injection, RF ablation, and LT4 treatment groups, respectively (P < 0.001). There was a significant relationship between the mean volume reduction and the follow-up period (one, three, and six months) (P < 0.001). Conclusion: The RF ablation therapy was found to be the optimal modality for the management of benign thyroid nodules, as it was associated with the greatest mean volume reduction. Conversely, the lowest mean volume reduction was observed in the LT4 treatment group during six months of follow-up.