[M] Is there a role for radiofrequency, thermal, or alcohol ablation in the management of TA or TMNG?

Alternative techniques have been employed for the ablation of hyperfunctioning thyroid nodules; these include percutaneous ethanol injection (PEI) under sonographic guidance, as well as thermal and radiofrequency ablation. Data supporting the safety and efficacy of such techniques come largely from outside the United States (184–186). Long-term follow-up exists to 5 years, showing that PEI is effective and safe. In a large series of 125 patients, Tarantino et al. demonstrated an overall cure rate (absent uptake in the nodule) of 93%, and a major complication rate of 3% (184). These included transient laryngeal nerve damage, abscess, and hematoma. All patients remained euthyroid (low/normal TSH and normal free T₃ and free T₄ estimates) during follow-up. The average reduction in the volume of nodules after PEI was 66%. Given the relative lack of experience with these alternative techniques, ¹³¹I therapy and surgery remain the mainstay of treatment. PEI or alternative treatments should be employed only in the very rare situation when standard therapies have failed, or are contraindicated or refused.