Thyroid RF Ablation is the FUTURE answer to unnecessary surgery

Thyroid No surgery for Thyroid, Parathyroid, Thyroglossal Duct, and other Neck Cysts and Recurrent thyroid cancer lymph
nodes. Ethanol Ablation is the Treatment of Choice to avoid unnecessary surgery.

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 FDA approved in the USA for soft tissue.  This means it can be used for thyroid nodules but there are no codes and insurance coverage.    I have developed a candidate evaluation system.I am training other interventional thyroidologists in the method and will begin clinical trials and am now treating 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.

 

 

 

                                    The Voice Over for the Thyroid RF Video

“ I am Richard Guttler board certified endocrinologist, and clinical thyroidologist in private practice with special interest in non-invasive methods to decrease unnecessary thyroid surgery.Today I am showcasing thyroid radiofrequency ablation for benign thyroid nodules. This simple outpatient procedure is done in my office with no general anesthesia or conscience sedation, just a local.

The patients are selected for thyroid RF when they have a symptomatic benign nodule or a cosmetic They need to have benign prior needle biopsies, normal thyroid tests, and clotting screen. A pre-RF image is taken of the neck.

The ultrasound is used to evaluate the nodule and to locate dangerous These include the vagus nerve, esophagus, trachea, carotid and the danger triangle with the recurrent nerve. Also it is used to make sure the electrode entry way is clear of blood vessels in the isthmus.

 

The RF room has a patient has a table,ultrasound,generator,ice water pump, and on /off foot pedal to control the hot tip. The generator has adjustable watt control, and there are 2 grounding pads to apply to the patients thighs. O2 sensor, BP and Pulse are monitored by my roving nurse. Standing emergency tray has iced saline for any voice changes, Tylenol for mild pain and anti-nausea medications. The adjustable watt control allows increases to better effect ablation or decreases to accommodate a patient compliant of some pain.

 

The RF System ( RF Medical Korea ) includes a generator, ice water pump, a power source off/on foot pedal, grounding pads, and the electrode.

The electrode is only 7 cm long and has a thin needle with a hot tip of 3-10  This is ideal for working in the small space of the neck. The ice water from the pump circulates around the needle to keep the rest of the electrode cool

The patient has their head in a donut at 6 degrees elevation, and has a blind fold or can elect to watch from an overhead I am at the head of the table facing the generator at the foot of the table. There are 2 screens and the Sonographer stands on the patients side and monitors the ultrasound, and the insertion direction of the electrode on one screen while I monitor the other screen and the generator.

My sonographer helps locate the best position in the nodule and after I am satisfied the location is safe, I activate the heat with the foot  When significant ablation occurs I use the foot pedal to turn off the heat.

This is done over and over to different areas of the nodule until the total volume is 

My roving nurse is monitoring the patient’s voice and any symptoms during the  She also records vital signs, and can on my directions adjust the wattage.

 The superior and inferior extent of the nodule is marked with red marker on the patients neck. 

The midpoint of the nodule is marked with an X.

The X is the entry point for first the local injection of the skin, then thyroid capsule, the  cyst drainage if needed and then RF electrode.

The thyroid capsule has sensory nerves that can cause pain.   

I inject 1% lidocaine along the outside pericapsular space of the thyroid capsule before I start the ablation. Also the cystic fluid if present is drained before the RF

 

 The electrode is inserted through the isthmus in a direction away from the danger triangle. This is called trans-isthmic approach.

The procedure uses US guidance to position the electrode in a series of places in the nodule usually from inferior/posterior to inferior anterior in each section of the nodule during serial 10 mm ablation zones. This can usually take 30-45 min

US images show the area of ablation by hyper echoic echos whitish in color.  The electrode is then moved to a different area. 

Caution is taken to not get too near the capsule while the electrode is activated.

The post RF US will show the areas in the nodule ablated by hyper echoic whitish pattern .

The patient is observed for 15-30 minutes and then returns to the examination room. Questions about how they felt during and if they have any side effects. A picture and a video of the neck is then taken.

The patient returns at 1, 3, 6, and 12 months for US and repeat symptom and cosmetic questionnaire and scores.

 A well trained interventional endocrinologist is the best physician do the thyroid RF and it can be done without visiting a hospital.”

 

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