Transarterial embolization outperforms radiofrequency ablation for thyroid goiters exceeding 100 mL: a study on efficacy and safety

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Abstract
Objectives This study aimed to compare the efficacy and safety of radiofrequency ablation (RFA) and transarterial embolization (TAE) in managing large benign thyroid nodules (BTNs), particularly those exceeding 100 mL, where established guidelines are limited. Materials and methods This retrospective multicenter study, conducted from January 2018 to May 2022, included 70 patients with a total of 76 large BTNs. Of these, 53 underwent RFA and 17 underwent TAE. Nodules were categorized by initial volume (< 50 mL, 50–100 mL, > 100 mL) and diameter (< 6 cm, 6–9 cm, > 9 cm). Treatment efficacy was evaluated using the volume reduction rate (VRR) at 6 months. Complications, as well as improvements in symptoms and cosmetic scores, were documented and analyzed. Results At 6 months, TAE demonstrated a significantly higher mean VRR than RFA (p = 0.007), especially for nodules larger than 100 mL (TAE: 63.34% vs. RFA: 49.71%; p = 0.035). The complication rate in the TAE group (5.26%) was lower than that in the RFA group (14.03%), where transient hoarseness and hematoma were common complications. Both treatments resulted in significant improvements in symptom and cosmetic scores (p < 0.001), with TAE providing greater improvements in larger nodules. Conclusion TAE is more effective and has fewer complications than RFA for the treatment of large BTNs exceeding 100 mL. These findings suggest that TAE may serve as a minimally invasive alternative to surgery for patients with large thyroid nodules. Key Points Question What are the optimal minimally invasive treatment strategies for large benign thyroid nodules considering efficacy and safety? Findings Transarterial embolization (TAE) achieved a higher volume reduction rate with fewer complications compared to radiofrequency ablation (RFA) for large thyroid nodules exceeding 100 mL. Clinical relevance TAE offers a safer and more effective minimally invasive alternative to RFA for large thyroid nodules, improving patient outcomes with fewer risks. Graphical Abstract

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