AFTN, Toxic Nodule in a Teenager: Alternatives to Surgery
Some patients with autonomously functioning thyroid nodules (AFTN) are not suitable for surgery or radioiodine therapy. Being a 13 Y/O would be one reason for concern for the family. Therefore, minimally invasive alternative treatments, such as ethanol ablation or radiofrequency ablation (RFA), are indicated and are not malpractice as stated by the original ENT surgeon..
RFA seems to be effective and safe for the treatment of AFTN.
The parent of 13 Y/O teenage female was confronted with a major decision about the treatment of a large visible nodule which had suppressed TSH and normal T4 and T3 and antibodies for Graves or Hashimoto’s thyroiditis. She did not want her youngster to have surgery as recommended by her ENT. She was told it was a solid nodule, but on second opinion found out it was full of cyst fluid. The nodule was showing cystic degeneration possibly from traumatic injury from gymnastic exercises. Many degenerate and loose there potential to produce toxic hyperthyroidism.
Because of the large volume of fluid and the fact she was not clinically hyperthyroid we laid out a plan based on deferring drastic neck surgery for alternative non-invasive methods.
- Because there was significant cyst fluid ethanol ablation was the first step. It is safe and can be easily done as an outpatient.
- Follow up T4, T3 and TSH to monitor her function.
- If TSH is normal we can wait for a time. If it is still low we can move to the second phase.
- The solid part would be a candidate for RFA. This has been successful in treating the AFTN.
- If after years there is regrowth and toxic nodule production of hyperthyroidism she will be old enough for radioiodine, surgery or another session of RFA.
- The ENT surgeon told the family “Anything other than surgery is malpractice”.
- Comment: Don’t get bullied into having surgery.Do your own research and look for alternatives.Seek expert opinions of possible other available first line theraoies that do not require surgery.
- Call me at 310-393-8860 and talk to Matt on details.
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