10
Treatment
Figure 4. Strength of Consensus from Delphi Survey
Recommendation 1: Eligibility and contraindications to TA should be thoroughly
evaluated during a dedicated US examination and consultation by the operator.
Recommendation 2: Shared decision making with the patient, duly informed of the
advantages and disadvantages compared to observation, surgery (or radioiodine when
appropriate) is mandatory.
Recommendation 3: Ethanol ablation can be used as an adjunct therapy, either in
a sequential or combined procedure with TA, for nodules with a significant cystic
component.
Recommendation 4: Consistent use of the trans-isthmic approach and moving shot
technique help to decrease thermal injury to adjacent critical structures and the skin.
Recommendation 5: roughout the procedure, routine monitoring for potential
complications is recommended. If a complication occurs, mitigation techniques may be
used, and there should be a low threshold for halting the procedure and transferring to
appropriate level of care if necessary.
Recommendation 6: Immediate post-procedure inflammation and discomfort
are generally well managed with ice packs and non-steroidal anti-inflammatory
medications. Opioid medications are generally unnecessary and should be avoided.
Recommendation 7: Long-term follow-up with clinical, laboratory and sonographic
evaluation at 1, 6, and 12 months is recommended following ablation of thyroid nodules.
Recommendation 8: For their first 20–60 RFA procedures, clinicians should consider
treating small to moderate benign thyroid nodules.
Recommendation 9: Prior to starting thyroid RFA practice, clinicians and surgeons
should be proficient in US thyroid imaging and fine needle aspiration (FNA). e
learning curve can be mitigated by practicing on phantoms and having expert proctoring
of the first few cases.
Disagree/Strongly Disagree Neutral Agree/Strongly Agree
