Predictors of Suboptimal Response After Radiofrequency Ablation of Benign Thyroid Nodules

Objective: Radiofrequency ablation (RFA) has gained recognition as a minimally invasive alternative to surgery for managing symptomatic benign thyroid nodules. However, predicting RFA efficacy remains challenging, especially in identifying patients who may require multiple treatment sessions. The aim of the present study is to identify predictors of suboptimal volume reduction (SVR), defined as failure to achieve a volume reduction greater than 5% between 6 and 12 months after procedure and persistence of symptoms. Methods: A retrospective single-center analysis of consecutive patients who underwent a single RFA procedure for benign thyroid at Verona University Hospital between 2020 and 2023 was conducted. Clinical data, including nodule volume and compressive symptoms, were collected preoperatively and at 1, 6, and 12 months post-RFA. Regression analysis was performed to identify predictors of SVR and persistence of symptoms. Results: A total of 50 patients were included. Baseline nodule volume, higher ACR-TIRADS score, and higher body mass index (BMI) were identified as independent predictors of SVR (p < 0.05). At 12 months, 18.4% of patients reported persistent compressive symptoms; however, no significant predictors of symptom persistence were identified. Conclusions: RFA is effective in reducing benign thyroid nodule volume, with a minority of patients experiencing persistent symptoms. Baseline nodule volume, ultrasonographic characteristics, and BMI significantly influence RFA outcomes, suggesting the need for additional procedures. Further studies are required to identify predictors of treatment response, enhancing patient selection and optimizing therapeutic efficacy.