Welcome to the Thyroid Ethanol and Radiofrequency Ablation Center of Santa Monica.

Master’s class in thyroid ethanol ablation PEI and Radiofrequency ablation RFA is now available to endocrinologists. A new procedures you can learn at my side for 3 days. ( check out master’s class section for details).

Since 1998 we have been treating thyroid patients with ethanol. This is called PEI. Most don’t know it is the treatment of choice for mixed benign thyroid and parathyroid cystic nodules. It is the preferred method to ablate a nodule without to need for a thyroid surgery. Primary physicians, surgeons and a surprising number of endocrinologists say the procedure is painful and dangerous. It is a safe outpatient 10-20 minute procedure done in my center. No hospital, scar, no need for thyroid hormone replacement for life, and no serious complications.

Since 2o02 since Radiofrequency was first used in Korea to a ablate solid benign thyroid nodules. 5 years ago I travel to Italy to train in thyroid RFA. I had several RF systems in my office and trained several thyroidologists. The Korean system with short probe and thin needle was the best available for thyroid work. It is still FDA approved in the USA for soft tissue.  This means it can be used for thyroid nodules but there are no codes and no thyroid FDA approval yet.  I did not want to wait until patients could have RFA in the USA. Therefore I have developed a candidate evaluation system to allow my patients to travel to Italy or Korea just to have the therapy. My patients are pre-approved and only stay for 2 days just for the treatment. They return to have me do the followup.I am training other interventional thyroidologists in the method and will begin clinical trials and finally will treat my patients in my center in Santa Monica. There is sections on this website and my top thyroid blog on both PEI and RFA. If you have a large benign nodule or cyst you need to read all about my alternative therapy options to a thyroid surgery. Also if you have had thyroid cancer after surgery, and neck dissection and have a recurrence consider PEI  or RFA in place of another surgery.

Welcome to My World

Richard Guttler MD,FACE,ECNU        Interventional Thyroidologist

1-310-393-8860                             Thyroid.manager@protonmail.com

How does it work to get alternate ablation therapy?

Thyroid Radiofrequency Ablation RFA

1. Prior evaluation with ultrasound and biopsy confirmed you have a benign > 50% solid thyroid nodule.
2. You have local symptoms in the neck and or have a cosmetic problem with the looks of the large nodule.
3. Send all records of Ultrasound biopsy and thyroid blood tests via my secure email, thyroid.manager@protonmail.com. Please include a CD of the ultrasound and the actual slides and report from the biopsy. Mail to  me at 1328 16 th street Santa Monica Ca 90404
4. After my review of your material you need to set up an appointment with Alicia by email or phone 310-393-8860.
5. The evaluation can be done in one visit. This includes a new biopsy with molecular markers.The fee is $1750.We do not accept any insurance as payment. Cash must be paid in advance of the visit.
6. If you are a candidate after review of all the data including contact with the expert who will do the RFA and you agree to travel to Italy or Korea for the 2 day visit for the actual treatment I can help you arrange the visit.
7. Th expert in Italy is a interventional thyroidologist and has a RFA center in Northern Italy 6-13 hours from the east and west coasts of USA.
8. Korea is 13+ hours from the USA in Seoul. The expert is an interventional radiologist doing RFA for many years.
9. Both places require you pay for airfare, and treatment fee.
10. The Italian center will also pay for your overnight stay and transfers to and from the airport and hotel to the center.
11. Both are great Countries to visit as a tourist and many have timed the treatment with a spring vacation.
12. August is not available as the professor is like all Italians on vacation.
13. The fee for the Italian RFA treatment is $3500EU.
14. The fee in Korea is ?

Thyroid Ethanol Ablation PEI

1. Prior evaluation with ultrasound and biopsy confirmed you have a benign cystic thyroid nodule.
2. The fluid contents is at least 50% of the nodule with the rest solid.
3. You have local symptoms in the neck and or have a cosmetic problem with the looks of the large nodule.
4. Send all records of Ultrasound biopsy and thyroid blood tests via my secure email, thyroid.manager@protonmail.com. Please include a CD of the ultrasound and the actual slides and report from the biopsy.Mail to 1328 16 th street Santa Monica Ca 90404.
5. After my review you need to set up an appointment with Alicia by email or phone 310-393-8860.
6. The evaluation can be done in one visit. This includes an new biopsy with molecular markers.
7. If you are a candidate after review of all the data, you can return in 2-4 weeks for the PEI treatment.
8. My center is 7 miles from L.A. International Airport in Santa Monica. We have motels and major hotels within minutes of my center.Major attractions are near and also world class restaurants and food trucks.
9. You will have a 10 minute treatment and can leave after 30 minute observation and fly home.
10. With rare complications needing treatment it can be handled with your local endocrinologists or primary.
11. You will leave with my personal cell to discuss any problems the may arise after the treatment.
12. The evaluation and treatment is no covered by your insurance. You need to pay cash in advance of the evaluation, and if needed in advance of the treatment.
13. The evaluation part fee is $1750 US, and the PEI treatment is $2500.
14. One year free followup with Ultrasound and repeat PEI if indicated. is included.

Out of Network Second Opinion Before Surgery for Thyroid Nodules and Cancer

How Does it work?

Ask for your records to be sent to a thyroid expert for review before you consider surgery as the correct treatment. Some patients turn out to not have cancer. Some have a tumor that was called cancer in the past but now is a benign tumor.Some have a small thyroid cancer that active surveillance like prostate cancer can be used instead of surgery. Also ethanol ablation or radiofrequency can ablate it while it is small as a third alternative. Come to see me for an evaluation before you you consider surgery.

Why a second opinion? It can confirm that you are doing the right thing.

2/10  did not agree with the original DX of cancer.

4/10 indeterminate FNA biopsies were confirmed on second opinion.

2/10 Indeterminate FNA biopsies were non-diagnostic on second opinion..

 4/10 indeterminate FNAs were benign on second opinion.

13/100 Indeterminate FNA biopsies on initial cytology had cancer at surgery.

30/100 indeterminate FNA biopsies from second opinion had cancer.

14/100 did not have cancer on second opinion.

5/10 indeterminate cases had a different diagnosis on second opinion.

43/100 indeterminate biopsies  had a definite benign result on second opinion.

1. It can change the diagnosis.

2. It can change the extent of surgery.

3. It can find the type of cancer has been downgraded to benign.

4. It can find that you had a nodule that was incompletely evaluated before recommending surgery.

5. It can help you find non-surgical treatment for benign nodules and some thyroid cancers.

6. It can find that your small cancer is harmless and can be best treated by just yearly ultrasounds or ethanol ablation instead of surgery.

7. It can help you find alternative treatment specialists for small cancers in the thyroid and local recurrent cancers.

8. It can determine if a nodule or cancer can be treated with minimally invasive ethanol or radio frequency ablation instead of surgery.

   9.Finally it can direct you to high volume thyroid surgeons with low complication rate.

9. Second opinion is not a wasted time.It is giving you peace of mind that you are doing the right thing.

                                  Thyroid Ethanol Ablation

1. Cystic thyroid and parathyroid benign nodules.
2. Recurrent thyroid cancer neck lymph node metastatic disease.
3. Primary encapsulated micro-papillary cancers  

Small <1.5 cm primary cancers as alternative if the patient does not want surgery or long periods with a cancer in the neck they can opt of ethanol ablation.  

Ultrasound-Guided PEI thyroid mixed cysts,
Parathyroid cysts, thyroid cancer lymph nodes. and small <1.5 cm primary cancers

Thyroid Ethanol Ablation 101: Alternative to more thyroid cancer surgery or Radioiodine.

Posted 8 hours ago by Dr Guttler

2 0 0

Thyroid Ethanol Ablation 101: Alternative to more thyroid cancer surgery or Radioiodine.

More Use of Alternative Treatment Without Complications and Expense of Surgery or Radioiodine is Needed for Recurrent Thyroid Cancer in the Lymph Nodes.

More Use of Alternative Treatment Without Complications and Expense of Surgery or Radioiodine is Needed for Recurrent Thyroid Cancer in the Lymph Nodes

Before Ethanol Ablation PEI                            After 10 months post PEI

Management of recurrent and persistent metastatic lymph nodes in well-differentiated thyroid cancer: a multifactorial decision-making guide.

Dr.Guttler’s Comments:

1.Well-differentiated thyroid cancer (WDTC) recurs in up to 30% of patients.

2.  They fail to guide the clinician as to the multitude of factors that should be taken into account.

3. The Thyroid Cancer Care Collaborative (TCCC) is a web-based repository of a patient’s clinical information.

4. Ten clinical decision-making modules (CDMMs) process this information and display individualized treatment recommendations.

5. Surgery remains the most common treatment in recurrent/persistent WDTC.

6.  However, careful observation may be the recommended course in select patients.

7. Reoperation yields biochemical remission rates between 21% and 66%.

8. There is a reported 1.2% incidence of permanent unexpected nerve paralysis and a 3.5% incidence of permanent hypoparathyroidism.

9. Percutaneous ethanol ablation has been reported as therapeutic alternatives.

10.Radioactive iodine is not primary therapy  for metastatic lymph nodes.

Ethanol ablation PEI saves money and is effective in ablating recurrent thyroid cancer lymph nodes.

Go to Mayo clinic and see Dr. Ian Hay. His study saved 35 patents $1.5 million in surgery costs and did not have one single major complication of nerve or parathyroid damage.

or see me for the same PEI therapy.

Call 1-310-393-8860 or thyroid.manager@protonmail.com for details if you have been told to risk more complication potential with another neck surgery.

Richard Guttler MD,FACE,ECNU

Interventional thyroidologist

thyroid.com

Thyroid Radiofrequency Ablation RFA

1. Surgical alternative for benign solid or mixed nodules.
2. Surgical alternative for toxic and autonomous functioning thyroid nodules AFTN.
3. Surgical alternative for Recurrent lateral neck lymph node metastatic papillary thyroid cancer.
4. Surgical and Active surveillance alternative for primary micro-papillary <1.5 cm cancers.

Thyroid No Surgery: Very Large Benign Thyroid Nodules 101: Radiofrequency Ablation RFA can treat these massive nodules without surgery !

My patient just returned from Korea where her 10 cm nodule was ablated 90% with two sessions. She was done under local so the operator could tell if she had symptoms. Many places doing RFA put the patient to sleep and can’t monitor the voice. This allows discovery of symptoms after the procedure. She returned and told me there were no complications. Many operators will not do massive nodules and refer them to surgery.

This patient went to have RFA evaluation in Europe and because of the size of the nodule was told to have surgery instead.

My patient had the exact size 10 cm nodule and traveled to Korea

and had two sessions of thyroid RFA with 90% reduction of the nodule.

She is planning to go back in 6 months to complete the ablation of the remaining 10%.

If you are a patient with a large nodule and have put off the surgery for years

now is the time to remove it without surgery.

Call me at 310-393-8860 or email to thyroid.manager@protonmail.com

After I determine if you are a candidate for RFA I will arrange the treatment.

in Europe or Korea.

The evaluation includes a examination ultrasound and repeat FNA, molecular markers for cancer from the nodule.

We need to be sure there is no cancer with a low risk <3%.

Richard Guttler MD,FACE,ECNU

Interventional Thyroidologist