High-intensity focused ultrasound (HIFU) therapy for benign thyroid nodules without anesthesia or sedation

Background: Thermal ablation of thyroid nodules has gained momentum due to the possibility to avoid surgery. High-intensity focused ultrasound (HIFU) allows thermal treatment by energy ultrasound beam inside the targeted zone. Aim of our study was to evaluate the effects of HIFU treatment using Beamotion mode without anesthesia. Methods: Since 2016, patients with normal thyroid function, benign thyroid nodules with diameter no larger than 4 cm, and presenting local discomfort and/or compressive symptoms were treated by HIFU. We performed Beamotion HIFU and did not use anesthesia. Nodule size and thyroid function were evaluated before HIFU and 6 and 12 months later. Complications to therapy and tolerability of patients were also recorded. According to local ethical committee, for this retrospective study formal consent was not required. Results: The final series included 26 nodules from 26 patients with estimated volume of 2.81 ± 2.04 mL, treated by a power of 33.3 ± 10.3 W/site and energy of 2.1 ± 1.1 kJ. Nodules volume was significantly (p < 0.0001) reduced at 6 months of follow-up (1.83 ± 1.63 mL), and further at 1 year (1.57 ± 1.47 mL). Mean percentage of reduction over time of nodules was 48%. A 73% of patients described good comfort during treatment, 100% experienced good comfort just after therapy, and tolerability was high. No complications were recorded. At one 1 year of follow-up, 85% of subjects reported a reduction of local symptoms. Conclusions: HIFU therapy is effective in reducing size of thyroid nodules with major diameter below 4 cm and can be performed without anesthesia.