Toxic Thyroid Nodule Case Report
44 yo WF with known thyroid nodule since 2014, now with symptoms of choking, difficulty swallowing, and foreign body sensation (something stuck in her throat). Severe anxiety at night when trying to sleep because of difficulty breathing. Her US report measure her left thyroid lobe nodule as 5.5 x 3.9 x 5.1 cm two years prior to her current evaluation. Her thyroid function is normal. TSH 0.65, Free T4 1.3. All biopsies have been benign.
Her current ultrasound demonstrates a 79 ml nodule (6.2 x 4.2 x 5.9 cm) which has a prominent internal cystic component. She elected to undergo US guided cyst decompression to temporarily reduce the size of the nodule. Over the next few weeks, she experienced significant relief, so then elected to undergo a repeat US guided cyst aspiration, immediately followed with US guided RFA of her prominent left thyroid nodule.
US guided cyst aspiration of a 79 ml nodule to remove 20 cc of clear fluid, followed by US guided RFA of the residual 59 ml nodule using the moving-shot technique. 66,000 Joules of energy was applied over 21 minutes.
18 Months after RFA:
She feels very good and occasionally notices the sensation of a nodule in the left lower neck. Denies compressive symptoms. US measurements demonstrate internal treated area of 7.5 ml with adjacent rim of viable thyroid now measuring 28 ml in total. Will continue periodic surveillance.
General Comment: This case is early in our experience with RFA and highlights the significant improvement is symptoms which one can experience with overall volume reduction. Today we would tend to apply even more energy into the nodule to further treat the edges which would help to reduce future margin regrowth of the nodule.