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However, the following risk factors have been proposed: BTNs near the anterior thyroid capsule, in which the neck space on the anterior surface of the thyroid may not be as tight as on the other sides; large and mixed component nodules consisting of highly heterogenetic tissue, which may require more RF power through the use of multiple ablations, a higher maximum RFA power, and a longer ablation time.[sup]
There is no established management protocol for nodule rupture of BTNs post-RFA.
However, this complication is rare after RFA of all types of organs, even after RFA and FNA of thyroid carcinoma.[sup],,, Two cases of needle track seeding were described after RFA for thyroid nodules that were proven to be BTNs by FNA.[sup],
At least two separate US-guided FNA or core needle biopsy procedures are crucial before RFA to characterize BTNs. Caution should be used with thyroid nodules with malignant US features, even if cytology yields benign results.[sup], During follow-up, increased or stable nodule volume should be reassessed carefully to avoid unsatisfactory treatment results, and yearly follow-up is recommended for 5 years.[sup],
The most probable reason for pain is parenchymal edema and thyroid capsule thermal damage.[sup] Other factors associated with the probability and severity of pain include monopolar RFA, location of the BTNs (especially adjacent to vulnerable vital structures), needle size, lack of expertise, and vigorous handing of the needle.
For solid BTNs, the rich blood supply of the BTN contributes to the susceptibility to post-RFA hemorrhage.
As a minimally invasive treatment modality for BTNs, RFA is safe and extremely well tolerated.
The BTN, therefore, functions as a stable currency.
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