Thyroid Nodule RFA 101: A Large Thyroid Nodule Case from Dr. Petros Tsamatropoulos of Centro Palmer Institute in Reggio Emilia Italy

Thyroid Nodule RFA 101: A Large Thyroid Nodule Case from Dr. Petros Tsamatropoulos of Centro Palmer Institute in Reggio Emilia Italy

Thyroid Nodule RFA 101: A Large Thyroid Nodule Case from Dr. Petros Tsamatropoulos of Centro Palmer Institute in Reggio Emilia Italy

RADIOFREQUENCY ABLATION OF A LARGE THYROID NODULE

Dr. Petros Tsamatropoulos

Dr. PETROS TSAMATROPOULOS, MD

Endocrinologist

He graduated from Rome University “La Sapienza” Medical School in Italy (2005). He completed his medical residency and endocrinology fellowship training at the same University Medical School (2010) before serving one year of active duty in the Army. From 2014 he works with Dr. Roberto Valcavi.

Email: petros@robertovalcavi.it

HEALTH-RELATED QUALITY OF LIFE AFTER PERCUTANEOUS RADIOFREQUENCY ABLATION OF COLD, SOLID, BENIGN THYROID NODULES: A 2-YEAR FOLLOW-UP STUDY IN 40 PATIENTS. Valcavi R, Tsamatropoulos P. Endocr Pract. 2015 Aug;21(8):887-96. doi: 10.4158/EP15676.OR. Epub 2015 Jun 29.

RADIOFREQUENCY ABLATION OF A LARGE THYROID NODULE

& Roberto Valcavi, MD, FACE

Dr. Roberto Valcavi

Biosketch

Roberto Valcavi, MD, FACE worked on Endocrine Neck (Thyroid, Parathyroid, Lymph-Nodes) Ultrasound since 1986. He developed Thyroid and Neck Diagnostic Ultrasound and all Ultrasound-Related diagnostic (FNA, Fine Needle Aspiration) and therapeutic techniques for benign cystic (PEI; Percutaneous Ethanol Injection) and solid nodules (thermal ablation with laser or radiofrequency). These interventional techniques, in selected patients, may avoid surgery. His main research and teaching areas are thyroid nodule, thyroid tumors, and parathyroid adenomas. He is author of numerous papers indexed on pubmed and reviewer for several European and North American Endocrine Journals. He is in the panel of authors of AACE-ACE-AME guidelines for thyroid nodule.

He is faculty of the AACE (American Association of Clinical Endocrinologists) Endocrine Certification Neck Ultrasound (ECNU) program. He is faculty of the Mayo Clinic (Rochester, MN, USA) Endocrine University. Since October 2014 he moved his clinical activities from the General Hospital to the Centro Palmer in Reggio Emilia

Tel.: + 39 0522 792400; + 39 0522 307856

The thyroid gland
Awards: 2004 International Clinician Award, ACE (American College of Endocrinologists); 2011 Certificate of Recognition AACE in appreciation to fostering the collegiality and interaction in the International endocrine community for the enhancement of endocrine practice and the betterment of care to all peoples of the world with endocrine disorders.

Email Dr. Valcavi: info@robertovalcavi.it 

Email Centro Palmer: segreteria@centropalmer.it

From the Endocrinology Unit, Centro Palmer, Reggio Emilia, Italy

RADIOFREQUENCY ABLATION OF A LARGE THYROID NODULE

Case presentation:

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ig. 1. Photos of the patient’s neck before (a) and 10 months after (b) radiofrequency ablation (RFA) of a large, benign, thyroid nodule.

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Ultrasound images in B-Mode showing the thyroid nodule before (a) and 10 months after (b) radiofrequency ablation.

A 29-year-old Caucasian female was referred to our Endocrinology Unit by her general practitioner (GP) because of a slowly enlarging neck mass. The patient mentioned that she had noticed a lump of the anterior neck becoming larger over time and causing her progressively esthetic concerns and swallowing problems. The patient’s GP, after having palpated her neck, suspected a thyroid mass. In our clinic we performed a thyroid ultrasound scan and found a predominantly solid, isoechoic, heterogeneous, thyroid nodule (TN) of the right lobe with regular margin 3.49 cm thick x 3.93 cm wide x 5.95 cm long (volume of 42.44 mL). Patient’s neck at the time of presentation and B-mode ultrasound image (transverse view) of the patient’s TN are shown in Figures 1a and 2a respectively. TSH blood level was 1.25microIU/mL (normal). Consequently, the patient underwent a fine-needle aspiration biopsy that revealed a benign Bethesda II class thyroid nodule. Since the TN was symptomatic we offered to the patient two treatment options: a. right surgical thyroid lobectomy or b. ultrasound-guided (UG) thyroid radiofrequency ablation (RFA) (1). The patient refused surgery and underwent UG monopolar RFA. We used a VIVA RF generator (STARmed, Seoul, Republic of Korea) connected to a star RF Fixed electrode (STARmed, Seoul, Republic of Korea). This electrode needle is straight, internally cooled, 7-cm-long, 18-gauge, and we chose a model with an active tip of 1.0 cm which actually is suitable for ablation of medium- and large-size TNs (2). The ablation was performed with a transisthmic approach according to the moving shot technique (3).

Ten months after thyroid RFA the patient’s neck and B-mode ultrasound image (transverse view) of the patient’s TN appeared as shown in Figures 1b and 2b respectively. The patient reported complete resolution of esthetic and compressive problems. Indeed, the TN shrunk to 1.81 cm thick x 2.54 cm wide x 3.08 cm long (volume of 7.36 mL), resulting in a volume reduction percentage of 82.66%.

Take home message:

Thyroid RFA is a valid alternative to surgery in the treatment of symptomatic benign thyroid nodular disease when surgery is refused or contraindicated. This treatment is performed in an interventional suite under conscious sedation and with local anesthesia. There is no need of hospital admission and the patient can return home on the same day of the ablation. In conclusion, monopolar thyroid RFA is an effective and safe treatment for debulking benign symptomatic TNs.

Comments:

There still is no Thyroid RFA FDA approved in the USA.Until then USA Patients with benign large thyroid nodules can be sent to Centro Palmer Institute to have RFA. After evaluation to see if the patient is a good candidate in my center the trip to Italy will be a short visit less than 3 days to be treated by Dr.Valcavi and Dr.Petros. The procedure usually takes less than an hour and you leave right after it is completed.A quick follow up ultrasound the next morning is done to confirm the ablation was a success.You are on the plane back to the US or on vacation and you will eat the best Italian food  in the world from the area  around Reggio Emillia ( Bologna, Modena, and Parma )

Call Matt at 310-393-8860 or email to thyroid.manager@protonmail.com for my referral system details.Prior references from patients who traveled to Dr.Valcavi available.

2 Comments
  • Dr. Petros Tsamatropoulos September 13, 2017 10:01 am

    Thank you Dr. Guttler! Glad you liked it!

    • Dr Guttler
      Dr Guttler September 14, 2017 6:55 am

      Petros,
      At ATA I will be pitching endocrinologists who want to be ready for RFA in the States to visit you and Roberto or go to Dr.Baek’s class.
      Dick

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