Thyroid No Surgery 101: Alternative Therapy is Here
More Reasons to Avoid Thyroid Surgery: Here Comes Non- or Minimally Invasive Treatment for Nodules,Cysts and Cancer
Gharib H. et al JCEM October 2013
This is an old review article on the subject. Much has happened since. Treating thyroid nodules was the exclusive job of the surgeons for 100 years. An enlarging nodule,one causing symptoms,one causing fear of cancer, and one becoming toxic were removed. The modern thyroid association ATA was once called the American Goiter Association AGA. Even in 2013 the evidence was these procedures were safe and effective. As of 2017 only ethanol ablation PEI was been used in the USA.
Even Bulgaria does ethanol ablation for cysts like this large one done by an endocrinologist friend of mine.
Even then it has been used sparingly. It appears the primary physician trusted their local surgeon to remove cysts rather than seek out an interventional thyroidologist or radiologist to treat their patient with less expensive and less invasive method. I can only conclude that the incentive to fill their local hospital was a higher priority for them than the patient’s welfare. I have been doing ethanol ablation of 15 years and still the number of cases actually referred by the primary physician is small compared to the patient’s own searching for alternatives to surgery on the web.
The patient found me on the web. Her primary told her ethanol was painful and dangerous and recommended surgery.
Every medical society endorses ethanol ablation as a first line treatment over surgery but still thousands every year are subjected to hospitalization,anesthesia, pain and suffering post op, loss of work, and long term complications such as parathyroid and voice nerve damage by low volume surgeons. Way too many thyroid surgeries are done by surgeons who do only a few cases a year with bad effects for their patients.Anywhere from up to 65 % more complications compared to high volume surgeons ( >25 Total TX)
year).Since the review in 2013 laser ablation has fallen out of favor replaced by Radiofequency ablation RFA. Again, this exciting treatment advance has failed to land on the shores of the USA. Europe,Asia are far ahead of us in the use of RFA. The companies making RFA systems have ignored the thyroidologists crying out for a Thyroid RF Mini-Probe.
Physician using the Thyroid RF Mini-Probe in Korea.
Post RF ablation area on contrast ultrasound
RFA being done in Korea with a Thyroid RF Mini-Probe. The operator was close contact with the short length and less bleeding with a thin bore needle. The destruction of the nodule is seen in the lower image.
The US companies have refused to continue research in RFA for the new exciting Microwave ablation leaving thyroidologists without funding to do research with a small probe. One company discontinued research into a small probe. The Koreans are also to blame for their failure to have their probe available to us for RFA treatment of benign nodules in the USA.
Using AceNeedleME you can see the difference in the ThyroidRF Mini-Probe and the loner thicker RFA probes available in the USA.
They have the ideal probe that I have labeled Thyroid RF MiniProbe, but had not had it available in the North American market in 2017. They do not have the thyroid probe FDA approved as we speak today. There have been no studies on US patients with the small probe, and only a few with the large probe not designed for thyroid use. I send my patients out of the country to get the best medical care that is not available here.
The 2013 review article endorsed PEI, and RFA but still in 2017 few physicians send their patients for these less invasive and safer treatments without surgery.
Two new methods were mentioned but were not reviewed because of too little data available. In 2017 High intensity focused ultrasound HIFU is another non-invasive method for thyroid nodules that is used throughout the world BUT not in the USA. USA companies spend their time developing prostate probes and others but no thyroid probe! It is a shame that we lag behind Europe in developing thyroid HIFU systems. I can have my patients fly to France,Germany,Italy, Asia, even China for thyroid HIFU. The French company making the thyroid HIFU system called Echopulse is just now trying to get FDA approval.
We are the biggest medical market in the world but foreign companies appear afraid to come up against our FDA.
The last is Microwave ablation MWA. It is still early to say what impact it will have on thyroid treatment.Antenna delivers the microwaves to the tissue.
Tags: ethanol ablation, HIFU, High Intensity Focused Ultrasound, Microwave ablation, MWA, radiofrequency ablation, RFA, thyroid nodules, thyroid ultrasound
Below: Microwave antenna -probe is #16 bore size and too long for the neck.
Richard Guttler MD,FACE,ECNU