| | Advantages | Disadvantages |
| Surgery[1] | - Immediate definitive management
- Prompt relief of symptoms
- A definite histologic diagnosis is obtained
| - Inpatient, although in some centers, lobectomy is performed as an outpatient procedure
- High cost
- Risk of hypothyroidism and surgical complications (eg, vocal cord paralysis, hypoparathyroidism) dependent on extent of resection but generally low with lobectomy
|
| Ethanol ablation[2] | - Outpatient
- Reduction in nodule volume (80 to 85%)
- Improvement in cosmetic concerns and compressive symptoms
- Avoidance of scars
- Avoidance of thyroid hormone replacement
| - Painful if not performed with sedation (can be mitigated with local anesthetic)
- Risk of chemical injury (recurrent laryngeal nerve or other structures)
- Less efficacy for complex cystic nodules with solid component >20% (the solid component can be treated with thermal ablation)
- Less efficacy with viscous cystic fluid content or in the presence of multiple loculations
- May need multiple sessions (risk of recurrence greater with large cysts [eg, >20 mL])
- Continued long-term monitoring with thyroid ultrasound
|
| Thermal ablation techniques[2] | - Outpatient
- Reduction in nodule volume (60 to 80%)
- Can be used for cystic nodules with a solid component >20%
- Improvement in compressive symptoms and cosmetic concerns
- Avoidance of surgical scars
- Avoidance of thyroid hormone replacement
| - Painful if not performed with sedation (can be mitigated with local anesthetic)
- Risk of thermal injury (recurrent laryngeal nerve or other structures)
- Risk of periprocedural bleeding requiring conversion to open surgery
- Need for multiple sessions
- Delayed diagnosis of missed malignancies
- Regrowth of treated nodules
- Continued long-term monitoring with thyroid ultrasound
|
