BACKGROUND
The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules.


SUMMARY
This consensus statement is organized around three key themes: i. safety of ablation techniques and their implementation, ii. optimal skillset criteria for proceduralists performing ablative procedures, and iii. defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural and post-procedural settings are discussed including clinical factors related to patient selection and counselling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management and safe follow-up practices. Prior training, knowledge and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided.


CONCLUSIONS
Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counselling. Although these emerging technologies hold great promise, they are not without risk and require development of a unique skillset and environment for optimal, safe performance and consistent outcomes.

General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement

To compare the therapeutic efficacy and safety of microwave ablation (MWA) and lauromacrogol injection for ablation (LIA) for benign predominantly cystic thyroid nodules.In this retrospective study, 85 patients with predominantly cystic thyroid nodules (PCTNs) who underwent microwave ablation (MWA) or lauromacrogol injection for ablation (LIA) between June 2019 and August 2022 at three hospitals were included in our research. Forty-six patients were treated with microwave ablation, and thirty-nine patients were treated with lauromacrogol injection for ablation. The baseline characteristics, nodal volume, volume reduction rate (VRR), and incidence of postoperative complications were compared between these two groups.After treatment, there were significant differences in the thyroid nodule volume and the volume reduction rate (VRR) at different follow-up times between the groups (p < 0.001). There were no significant differences in the nodal volume or the volume reduction rate (VRR) between the MWA group and the LIA group at 1, 3, 6, and 12 months (p > 0.05). Of note, no serious intraoperative or postoperative complications occurred in the corresponding group.MWA and LIA are very effective and safe strategies for the treatment of predominantly cystic thyroid nodules. However, LIA is more advantageous in that it is less expensive and has a shorter length of hospital stay than MWA. 

Comparison of the effectiveness of lauromacrogol injection for ablation and microwave ablation in the treatment of predominantly cystic thyroid nodules: a multicentre study

This review highlights opportunities to develop accessible ablative therapies to reduce the cancer burden in LMICs.

Locoregional Thermal and Chemical Tumor Ablation: Review of Clinical Applications and Potential Opportunities for Use in Low- and Middle-Income Countries

The mechanisms underlying subclinical hypothyroidism (SCH) remain unclear, making timely and accurate differentiation between hypothyroidism and SCH, as well as severity assessment, challenging. This study aimed to investigate the role of NFE2 like bZIP transcription factor 2 (Nrf2), gp 

Nrf2, gp91phox and IL-17 are associated with severity and clinical outcomes of patients with subclinical hypothyroidism: a comparative study

Multiple endocrine neoplasia type 1 (MEN1), a rare tumor syndrome, is inherited in an autosomal dominant pattern, mainly manifested as primary hyperparathyroidism (PHPT). Surgery is preferred for patients with MEN1 and PHPT. Thermal ablation has been widely applied for PHPT but rarely for postoperative recurrent PHPT in MEN1 patients. Based on a series of cases, we aimed to investigate the clinical efficacy and safety of ultrasound-guided percutaneous microwave ablation in the treatment of MEN1 patients with postoperative recurrence of PHPT. 

Microwave ablation for recurrent primary hyperparathyroidism in four patients with multiple endocrine neoplasia type 1: a case series report.

Objective To compare the efficacy and safety of ethanol ablation (EA) and microwave ablation (MWA) in the treatment of cystic or predominantly cystic thyroid nodules. Methods Patients with cystic or predominantly cystic thyroid nodules intervened with EA or MWA were retrospectively enrolled and divided into EA group (n  = 30) and MWA group (n  = 31). The volume and volume reduction rate (VRR) of thyroid nodules before ablation, and at 3 and 12 months after ablation were compared between the two groups. The effective rate (ER) and incidence of adverse events in both groups were recorded. Results The median VRR and ER at 3 months after ablation were significantly higher in EA group than in MWA group (81.30% vs 75.76%, P = 0.011; 76.67% (23/30) vs 51.61% (16/31), P = 0.040), while no significant difference was detected at 12 months (93.39% vs 88.78%, P = 0.141; 86.67% (26/30) vs 87.10% (27/31), P = 0.960). The median VRR of small nodules in EA group was significantly higher than that in MWA group (81.30% vs 71.18%, P = 0.006; 93.40% vs 83.14%, P = 0.032). There was no significant difference of median VRR in medium nodules at final follow-up between MWA and EA group (93.01% vs 89.68%, P = 0.482). Serious adverse events were not reported in both groups. Conclusion EA and MWA are both effective and safe in the treatment of cystic or predominantly cystic thyroid nodules. EA is more cost-effective and effective than MWA for small nodules, but it requires more cycles of treatment and may pose a higher risk of postoperative pain compared with MWA.

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

Multiple endocrine neoplasia type 1 (MEN1) is an inherited endocrine syndrome caused by the mutation in the tumor suppressor gene MEN1. The recurrence rate of primary hyperparathyroidism (PHPT) in patients with MEN1 after parathyroidectomy remains high, and the management of recurrent hyperparathyroidism is still challenging.We reported a 44-year-old woman with MEN1 combined with PHPT who was diagnosed through genetic screening of the patient and her family members. After parathyroidectomy to remove one parathyroid gland, the patient suffered from persistent high levels of serum calcium and parathyroid hormone, which returned to normal at up to 8 months after ultrasound-guided microwave ablation (MWA) for bilateral parathyroid glands, suggesting an acceptable short-term prognosis.Ultrasound-guided MWA for parathyroid nodules may be an effective therapeutic strategy for recurrent PHPT in MEN1 patients.

Ultrasound-guided microwave ablation in the treatment of recurrent primary hyperparathyroidism in a patient with MEN1: a case report

Correlation of subclinical hypothyroidism with sarcopenia and its components in the Chinese older adults.

Sarcopenia is closely associated with activity limitations, falls and fractures, all serving as major causes of physiological deterioration and even mortality in older adults. The purpose of this study was to develop and validate a novel nomogram for predicting the risk of sarcopenia in Chinese older adults from rural areas. Overall, 611 older adults were enrolled from the Thyroid Diseases in Older Population (TOPS) study and randomly assigned to the training and validation datasets in a ratio of 8:2. Based on the risk factors for sarcopenia identified by stepwise multivariate logistic regression, a nomogram to predict sarcopenia in older adults was created. Its discrimination ability, calibration accuracy and clinical utility were assessed via the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA), respectively. Additionally, a web-based nomogram was developed. A nomogram to predict sarcopenia in older adults was created by incorporating the following variables: age (years), sex, body mass index (BMI, kg/m2), free triiodothyronine (FT3), total cholesterol (TC), triglyceride (TG), and TG/HDL-C. The area under the curve (AUC) of the nomogram was 0.813 (95% CI 0.775–0.846) in the training dataset and 0.819 (95% CI 0.739–0.883) in the validation dataset. Both calibration curves and DCA verified high calibration accuracy and clinical utility of the nomogram. A nomogram is created based on routine laboratory values of blood testing, showing an outstanding ability to predict sarcopenia in older adults from rural areas in China accurately, specifically and cost-effectively.

A nomogram to predict sarcopenia in older adults: a multi-center study in rural China

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Papers

The influence of nodule size on clinical efficacy of ethanol ablation and microwave ablation on cystic or predominantly cystic thyroid nodules

Ultrasound-guided microwave ablation in the treatment of recurrent primary hyperparathyroidism in a patient with MEN1: a case report

Correlation of subclinical hypothyroidism with sarcopenia and its components in the Chinese older adults.

A nomogram to predict sarcopenia in older adults: a multi-center study in rural China