Radiofrequency Ablation in the Management of Extensive Multinodular Goiter: A Midterm Single-Center Experience
Szabo, Lorant et al. JVIR;36(10):1597 - 1604
Tell us about you, your team and your institution.
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Lorant Szabo, MD, EBIR: I am an interventional radiologist with eight years of experience in both vascular and nonvascular procedures. Our center is part of a tertiary care private hospital with a strong focus on a wide range of interventional treatments, including endovascular and percutaneous image-guided procedures. We work in close collaboration with endocrinology and endocrine surgery, particularly in the management of thyroid disorders.
Since 2016, our team has performed minimally invasive thyroid interventions, with extensive experience in image-guided ablation—especially for benign thyroid nodules and multinodular goiter. The team includes interventional radiologists supported by endocrine specialists who assist with patient selection and provide longitudinal care, including structured follow-up over 12 to 24 months.
Why did you pursue this topic?
Dr. Szabo: Multinodular goiter is a common condition, particularly in iodine-deficient areas, and traditional treatments—such as surgery or radioiodine therapy—are not always feasible or preferred by patients. We were driven by the need for minimally invasive alternatives, especially for patients who are not surgical candidates or who decline surgery. While radiofrequency ablation (RFA) has shown excellent outcomes for isolated nodules, its role in treating large, complex multinodular goiters had not been well established. Our aim was to assess whether RFA could serve as a safe and effective alternative to total thyroidectomy in appropriately selected patients.
What are the key takeaways from your research?
Dr. Szabo: RFA can achieve substantial and sustained volume reduction in large, symptomatic multinodular goiters—even in patients who would otherwise be surgical candidates.
Most patients experienced durable symptom relief and improved cosmetic outcomes, with a low complication rate. A staged treatment approach and selective retreatment of incompletely ablated or growing nodules can optimize long-term results. Thyroid function was preserved in all treated patients, including those with toxic nodules, who returned to a euthyroid state without surgery.
How might this research influence treatment, practice, or clinical processes in interventional radiology?
Dr. Szabo: Our findings support RFA as a viable, minimally invasive alternative to surgery for selected patients with benign multinodular goiter. This could broaden the scope of interventional radiology in thyroid disease management, particularly for patients who are poor surgical candidates or prefer to avoid lifelong thyroid hormone replacement. We anticipate that dedicated thyroid ablation programs may become more common, with improved patient selection protocols and the development of formal treatment guidelines.
What has been the patient response or feedback to RFA for multinodular goiter?
Dr. Szabo: Patient feedback has been overwhelmingly positive. Many were relieved to avoid surgery and the risks associated with general anesthesia, including potential complications such as hypoparathyroidism or vocal cord paralysis. They also appreciated the short recovery time and the preservation of thyroid function.
What challenges or considerations do you see in adopting RFA into routine practice?
Dr. Szabo: Key challenges include:
- Training and experience: Thyroid RFA requires specific technical skills and a thorough understanding of neck anatomy.
- Equipment availability: Not all centers are equipped with RFA generators and thyroid-specific electrodes.
- Patient selection: Careful evaluation with high-resolution ultrasound and endocrine consultation is critical.
- Protocol standardization: There remains a need for broader consensus on treatment staging, follow-up intervals, and procedural algorithms.
- Structured training programs and closer integration of interventional radiology with endocrine care will be essential to facilitate wider adoption.
Given the favorable long-term outcomes, how do you see the role of RFA evolving in thyroid disease management? What further research would be most valuable?
Dr. Szabo: We anticipate that RFA will increasingly be recognized as a first-line option for managing benign thyroid nodules and multinodular goiter, especially in patients who prioritize gland preservation. As long-term data accumulate, its role may expand even further.
Future research priorities include:
- Comparative trials between RFA and surgery or thyroid artery embolization
- Cost-effectiveness analyses
- Optimization of treatment protocols for large-volume goiters
- Investigation of expanded indications, including selected low-risk thyroid malignancies—such as papillary microcarcinomas, which are already being treated with RFA in some centers.
Any next steps or plans for follow‑up research?
Dr. Szabo: Yes. We plan to expand our patient cohort and investigate predictors of successful long-term outcomes, including nodule characteristics and technical parameters. Additionally, we are working on refining staging algorithms to guide treatment planning more effectively.
