High-intensity focused ultrasound for symptomatic benign thyroid nodules

2.1 Thyroid nodules may be cystic, colloid, hyperplastic, adenomatous or cancerous. Most thyroid nodules are benign and are usually asymptomatic. There may be a single thyroid nodule (solitary nodule) or multiple thyroid nodules (multinodular goitre). Some thyroid nodules produce thyroxine or triiodothyronine and cause thyrotoxicosis. These are called hyperfunctioning or toxic thyroid nodules.

2.2 Treatment of benign thyroid nodules may be needed if they cause symptoms or cosmetic problems. Conventional treatment includes surgery. Other less invasive approaches than surgery include ethanol ablation, percutaneous laser ablation, radiofrequency ablation and microwave ablation.

2.3 High-intensity focused ultrasound is a minimally invasive technique that aims to reduce symptoms and improve cosmetic appearance, while preserving thyroid function, and with fewer complications than surgery.

2.4 High-intensity focused ultrasound for symptomatic benign thyroid nodules is usually done using sedation and systemic analgesia, in an outpatient setting. The patient is placed in the supine position with moderate neck extension. The focused ultrasound device is positioned on the patient's neck to deliver the treatment and allow for simultaneous imaging of the treatment area. The technology uses high-energy sound waves that pass through the tissues, generating local heat and inducing coagulative necrosis, protein denaturation and cellular destruction. A strong acute inflammatory response follows. The treatment duration depends on the nodule size.