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METHODS article

Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1403087
This article is part of the Research Topic Recent Advances in Thermal and Nonthermal Ablative Technologies of the Thyroid View all 9 articles

Recurrent laryngeal nerve monitoring by Flexible Laryngoscopy during Thyroid Radiofrequency Ablation in the awake patient

Provisionally accepted
Marsida Teliti Marsida Teliti 1,2Antonio Occhini Antonio Occhini 3Rodolfo Fonte Rodolfo Fonte 2Laura Croce Laura Croce 1,2Benedetto Calì Benedetto Calì 3Federica A. Ripepi Federica A. Ripepi 1Andrea Carbone Andrea Carbone 4Mario Rotondi Mario Rotondi 1,2*Spyridon Chytiris Spyridon Chytiris 2
  • 1 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Lombardy, Italy
  • 2 Unit of Endocrinology and Metabolism, Laboratory for Endocrine Disruptors, IRCCS Fondazione Salvatore Maugeri, Pavia, Lombardy, Italy
  • 3 Department of General and Minimally Invasive Surgery, IRCCS Fondazione Salvatore Maugeri, Pavia, Lombardy, Italy
  • 4 Unit of Diabetology and Endocrinology, Medical-Oncologic Department, ASST Lodi, Lodi, Italy

The final, formatted version of the article will be published soon.

    Objective: Although radiofrequency ablation (RFA) is a safe and effective non-surgical treatment for benign thyroid nodules, injury to the recurrent laryngeal nerve (RLN), is a potential and feared complication. Intermittent voice checks have been proposed to monitor vocal cord (VC) function during RFA, but such assessment is highly subjective and effort-dependent.We are here reporting the methodological use of flexible laryngoscopy (FL) for VC monitoring during bilateral thyroid RFA treatment. The patient, a 35-year-old woman, was referred to the Endocrinology Unit for subclinical hyperthyroidism due to bilateral autonomously functioning thyroid nodules.Results: At the end of the treatment of the first nodule, the FL performed by an otorhinolaryngologist specialist allowed evaluating VC function and ruling out possible paralysis before proceeding with the contralateral RFA treatment. The patient was awake during the entire procedure and well tolerated the laryngoscopic examination. The TSH serum evaluations performed one month and 9 months after the procedure assessed an euthyroid state (TSH 3.2 mIU/L and 2.8 mIU/L, respectively).During bilateral thyroid RFA the use of FL for VC monitoring treatment resulted in a safe, easy-to-perform, and effective strategy to minimize and anticipate RLN injury risk in the awake patient. The prevention of RLN damage is advisable in the case of single RFA treatment, while it should be strongly recommended when RFA is performed on bilateral nodules.

    Keywords: flexible laryngoscope, Radiofrequency ablation, Recurrent Laryngeal Nerve, bilateral, Thyroid Nodule

    Received: 18 Mar 2024; Accepted: 28 Aug 2024.

    Copyright: © 2024 Teliti, Occhini, Fonte, Croce, Calì, Ripepi, Carbone, Rotondi and Chytiris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Mario Rotondi, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, 27100, Lombardy, Italy

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