Percutaneous microwave ablation of benign thyroid nodule

Background / Objective We describe a case of a 44-year-old male patient with a visible neck mass and discomfort. Thyroid ultrasound examination revealed an oval-shaped heterogeneous nodule in the right lobe with a large central cystic component and smooth margins measuring ~6.2x3.2cm [Fig. 1]. The nodule exhibits no high-risk features and was categorized as EU-TIRADS 3. Two fine needle aspirations with cytological examinations showed no malignancy. Microwave ablation (MWA) was suggested for minimally invasive treatment of this symptomatic nodule. Methods The cystic component of the nodule was aspirated before the ablation. Ultrasound-guided percutaneous MWA was achieved under local anesthesia using an 18 G antenna. In total, 6 MWA sessions were performed using an overlapping technique of 15W power for 5 to 10 minutes. Results No complications occurred during the procedure and the patient was discharged on the same day. Follow-up ultrasound examinations displayed a gradual reduction in nodule volume of 59% within 8 months [Fig.2] Conclusions Benign thyroid nodules are a frequently encountered pathology in the general population. Minimally invasive treatment techniques such as ethanol injection, laser and thermal ablation have been developed as alternatives for partial or total thyroidectomy. A recent meta-analysis (J. Ding et al., Ultrasound Quarterly, 2023) of ultrasound-guided benign thyroid nodule thermal ablation demonstrated that minimally invasive techniques were safer and more efficient in terms of relief of symptoms, cosmetic effect, complication rate, and hospitalization duration compared to surgery.