(A307) Fibrosis and Scarring Following Radiofrequency Ablation for a Non-Toxic Multinodular Goiter

Introduction: Radiofrequency ablation (RFA) is an appealing therapeutic option for patients with benign thyroid nodules (BTN) wishing to avoid surgery. RFA targets nodules of interest through frictional and conductive heat from an alternating electric current. The procedure is not believed to induce scarring beyond intended nodules, with heat restricted to 1-5mm from the electrode tip.

Methods: This is a case report describing one 48-year-old patient.

Results: A 48-year-old with Hashimoto’s thyroiditis and non-toxic multinodular goiter underwent a total thyroidectomy, complicated by extensive scarring and fibrosis. Prior to surgery, the patient had two RFA treatments for compressive symptoms with temporary relief. She had undergone two fine needle aspirations (FNAs) with benign findings. The patient had no prior surgical history of the head and neck. Considerable scarring and fibrosis were encountered throughout the procedure with more extensive adhesions on the right side, involving the right internal jugular vein at the middle thyroid vein level. The final surgical pathology was described as diffusely disrupted thyroid parenchyma, consistent with Hashimoto’s thyroiditis. In the absence of prior neck surgery or radiation, the substantial fibrosis and scarring were at least partially attributed to her two prior RFA treatments.

Conclusions: Based on literature review, this is the first report of internal scarring encountered intraoperatively during thyroid surgery, attributed to RFA. RFA is a reasonable alternative to surgery in the management of BTN. The controlled heat utilized in RFA does not typically result in thermal injury. This report details the adverse event of internal scarring as a consequence of RFA, which may serve as an important consideration for providers and influence management options when treating BTN.