Safety and Efficacy of Thermal Ablation for Benign Thyroid Nodules in Patients with or without Previous Thyroid Surgery

Purpose To examine the use of propensity score matching (PSM) to compare the safety and efficacy of US-guided thermal ablation (TA) as a first-line treatment for initial thyroid nodules versus as a second-line treatment for recurrent nodules following thyroid surgery. Materials and Methods This retrospective study included data from 693 patients with benign thyroid nodules (BTNs) who underwent US-guided TA between January 2015 and July 2023. These included 619 patients in the initial nodule group and 74 patients in the recurrent nodule group. PSM was employed to balance preablation data and minimize confounding bias between the two groups. The perioperative and post-TA complication rates of the two matched patient groups were compared. Nodule volume and volume reduction rate (VRR) were compared at 1, 3, 6, and 12 months after TA. Thyroid function, symptoms, and cosmetic scores were also compared. Results Successful matching of 222 patients (mean age ± SD, 55.92 years ± 12.08; 172 female) (2:1 ratio) was achieved, with 148 patients in the initial nodule group and 74 patients in the recurrent nodule group. There was no evidence of a difference between the two groups regarding incidence of major complications (<i>P</i> > .99), minor complications (<i>P</i> = .82), or adverse effects (<i>P</i> = .51). The difference in VRR between the two groups at each follow-up point was not statistically significant (<i>P</i> = .30, .28, .33, .20, .33, respectively). At the last follow-up, symptom and cosmetic scores were significantly reduced in both groups (both <i>P</i> < .01), whereas serum thyroid hormone levels were not significantly different from those before TA treatment (all <i>P</i> > .05). Conclusion US-guided TA treatment exhibited a favorable safety and efficacy profile for patients with BTNs, regardless of prior thyroid surgery. <i>Supplemental material is available for this article.</i> © RSNA, 2025 <b>Keywords:</b> Head/Neck, Thyroid, Treatment Effects, Efficacy Studies, Ablation Techniques (Radiofrequency, Thermal, Chemical).