Thyroid No Surgery # 4 Avoid surgery for thyroid and parathyroid cysts

Thyroid No Surgery # 4 Avoid surgery for thyroid and parathyroid cysts

Thyroid No Surgery # 4 Avoid surgery for thyroid and parathyroid cysts

Thyroid No Surgery # 4 Avoid surgery for thyroid and parathyroid cysts

You have known there was a nodule and it was mostly full of fluid for years. You have had your physicians biopsy it and even drain the fluid multiple times. Your local surgeon recommended you should remove it even though the biopsies have been negative.  It is continuing to grow and begins to give you symptoms, and you don’t like the looks of it. Your endocrinologist has tried thyroid hormone suppression without success. You need to explore an alternative method to deal with this complex cyst. There are 2 options.

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  1. If the fluid is <50% of the nodule volume it is better to have radiofrequency ablation RFA because there is a solid nodular component not responsive to the regular cyst treatment method of Ethanol Ablation PEI. There may even be a combination of PEI for the cyst part and RFA for the solid part. RFA treatment od solid thyroid nodules.
  2. PEI is a safe non-invasive non-surgical  method to treat these large cysts.
  3. How do I get evaluated for PEI?
  4. The evaluation is done by an interventional thyroidologist. Your thyroid records,blood tests,ultrasounds, and actual pathology slides from the needle biopsies are sent before your appointment. An over-night stay to include a new biopsy with molecular markers and classifier. Thyroid cysts have a possibility of papillary thyroid cancer and need to be comfortable there is no cancer before PEI is done.
  5. An endocrine neck ultrasound is done to make sure there are no abnormal lymph nodes, and other at risk nodules. Also the cyst will be carefully evaluated for any areas to worry about for cancer. A sample of fluid is removed to determine the liquidity of the cyst. Also the color if clear like water can suggest a parathyroid cyst instead of a thyroid cyst. A sample of fluid would be sent for parathyroid hormone PTH and Thyroglobulin TG. PTH in the fluid would make the diagnosis of a parathyroid cyst, and elevated TG would diagnose a thyroid cyst.
  6. At the conclusion of the PEI cyst evaluation, a determination is made that you are a candidate.
  7. You will return for your elective PEI treatment.
  8. The consent would include the complications and side effects. The complications are rare. The usual side effect is some minimal pain on withdrawal of the needle after the injection.
  9. After the consent you will be brought to the Treatment room. You will have sterile jell applied to your neck after it is cleaned.
  10. With the help of a sonographer the thyroidologist will  take  pre-PEI images. He will determine the volume of the cyst, and draw up ethanol 200 proof ( 50% of the volume) in a syringe.
  11. The sonologist/thyroidologist will position the needle with the help of his sonographer in the center of the cyst, and then slow removal of the cyst fluid continues until a residual 1-2 ml is left around the needle tip. The syringe is switched to the ethanol and slowly injected. When the ethanol is injected the sonologist will let it in for 10 minutes.He will wash the ethanol in and out several times and then remove the ethanol and the needle. He will warn the patient about the mild pain on removal of the needle.
  12. There is a lead glove laid over the neck for 15 minutes. A small band aide is applied and the patient is free to leave after the post PEI physician visit. The cell phone of the physician is given to the patient in case of a rare problem after the PEI.
  13. The patient can return in 1-3 months or sooner if the treatment is partially a success. A second PEI may be needed in <5-8 %.
  14. Failure to destroy the cyst after 2 tries is an indication to have surgery. The is a chance a small papillary cancer is in the wall of the cyst. However, even failed treatments resulting in surgery wasnot due to thyroid cancer in my cases.
  15. This alternative to surgery results in no hospitalization,no major surgery, post op pain and suffering, and no loss of work.
  16. The procedure takes 20 minutes.
  17. The cost is the same as a co-pay for a surgery.
  18. Matthew Foss my sonographer is waiting for your call at 310-393-8860. He can answer your question and if you like make an appointment for a PEI evaluation.
  19. A video of the procedure is on my website vimeo and Utube.
  20. www.thyroidnosurgery.com
  21. Richard Guttler MD,FACE,ECNU  Interventional Thyroidologist
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