Response to the Letter: Addressing Surgical Difficulty and Pathological Findings in Thyroidectomy Post-Thermal Ablation

Dear Editor:

We deeply appreciate Zhao et al.’s ¹ thoughtful correspondence and insightful comments on our recent article, “Surgical and Pathological Challenges Following Thyroidectomy After Thermal Ablation of Thyroid Nodules,” published in Thyroid in December 2024. ² It is both gratifying and inspiring to see this work spark meaningful discussions on such a critical and evolving topic.

As Zhao et al. ¹ mentioned, thermal ablation’s (TA’s) impact on subsequent thyroidectomy remains an area of concern. Our study reported that the difficulty of surgery, quantified using the Thyroidectomy Difficulty Scale (TDS) and Macroscopic Adhesion Score (MAS), was significantly higher in the ablation group. We agree that variations in technical approaches, patient selection, and the interval between ablation and surgery are critical factors contributing to differences in study outcomes. TA may directly cause thermal injury to the thyroid capsule and surrounding musculature, leading to tissue adhesions. In our study, we observed inflammatory reactions surrounding the ablation zone, suggesting that changes could extend to adjacent tissues. These inflammatory responses were most pronounced within the first 2 months following ablation, a period during which surgery could pose greater challenges. However, in our cohort, no patients underwent surgery during the acute inflammatory phase. Nevertheless, we observed significantly increased surgical difficulty and longer operative times in the ablation group.

Furthermore, the extent of adhesions and surgical difficulty may be influenced by factors such as nodule size and location. Some researchers, including those at our institute, have proposed more aggressive ablation strategies to completely ablate nodule margins to prevent regrowth, which may also heighten the risk of adhesions. ³

Differences in findings across studies, such as those by Dobrinja et al. and Piana et al., may stem from the use of descriptive assessments without control groups, limiting the objectivity and generalizability of their conclusions. ^4,5 Additionally, as Zhao et al. noted, Ma et al. ⁶ focused on patients with thyroid carcinoma, representing a relatively selected population with different treatment considerations than benign nodules, which may result in different surgical considerations.

We appreciate Zhao et al.’s interest and thoughtful suggestions. Further studies on adhesion mechanisms, ablation techniques, and optimal surgical timing are essential.