Propensity-matched analysis of treatment outcomes of thermal ablation versus surgery for multinodular goiters

Multinodular goiter (MNG) faces the challenge of recurrence after surgery. The usefulness of thermal ablation (TA) for MNGs and its effectiveness compared to surgery are unclear. This study aimed to investigate two-year treatment outcomes of TA versus surgery for selected MNG.

The selection for MNG patients fulfilled over 50% normal tissue, 2-5 benign nodules and 1-3 well-defined dominant target nodules with maximum diameter ≥20 mm and/or with clinical complaints. Those who underwent complete ablation of dominant nodules in a single TA were retrospectively compared with those who underwent lobectomy or subtotal thyroidectomy after propensity score matching (PSM). Efficacy, all nodules burden changes, complications and health-related quality of life (HRQoL) were analyzed during two years. Complete relief (CR), stable disease (SD), progressive disease (PD) and retreatment rate were to assess all nodule burden changes.

Eighty-six pairs (1:1) were identified using PSM. At 24 months, the volume reduction rate of ablated nodules was 98.32% without regrowth. No significant differences were observed in the PD (9.30% vs 6.98%, p = 0.577), retreatment (1.16% vs 2.33%, p = 0.560) and complications (1.16% vs 4.65%, p = 0.173) between the TA and surgery group. TA was superior to surgery in the cosmetic outcome, hospitalization time (3d vs 8d, p < 0.001), estimated blood loss (3 mL vs 20 mL, p < 0.001), hypothyroidism (0 vs 61.63%, p < 0.001) and HRQoL.

For selected MNG, TA did not show higher retreatment risks than surgery with better thyroid function protection and quality of life during two years after a single complete TA of all dominant nodules.