Evolving patient preferences from surgery to thermal ablation in solitary thyroid nodule treatment

A changing landscape of patients' preferences for treatment of solitary and benign thyroid nodules (SBTN) form conventional surgery to other minimally invasive treatments (MITs) has been witnessed. The aim of this study was to evaluate indications, patients' preferences and outcomes of conventional surgery vs. transoral endoscopic thyroid surgery by vestibular approach (TOETVA) vs. laser ablation (LA) treatments for SBTN. This prospective cohort study included patients with SBTN causing compression symptoms treated at our institution throughout 2020-2023. Primary endpoint was patients' preferences for treatment. Secondary endpoints were: success rate, overall morbidity, need for second line treatment, and satisfaction rate. Some 204 patients (F: M = 161:43) with SBTN were offered conventional surgery (thyroid lobectomy) vs. TOETVA vs. LA. Patients' preferences were: 23 (11.3%) for conventional surgery vs. 17 (8.3%) for TOETVA vs. 164 (80.4%) for LA (p < 0.01). Overall morbidity was 2/23 (8.7%) for conventional surgery vs. 2/17 (11.8%) for TOETVA vs. 3/164 (1.8%) for LA (p < 0.01). Volume reduction ratio (VRR) for LA was 63% (range: 32 - 98%) at 6 months following treatment. Spongiform nodules vs. predominantly solid tumors vs. solid tumors had VRR of 83% vs. 67% vs. 51%, respectively (p < 0.01). Second line treatment was needed for 3/101 (3.0%) patients following LA within a 3-year follow-up. Satisfaction rate was higher for LA and TOETVA vs. conventional surgery (p < 0.01). Currently most patients prefer MITs for SBTN. TOETVA is chosen by minority of patients with a strong motivation to avoid scar whereas thermal ablation is the preferred MIT nowadays.