AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS…… GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES–2016 UPDATE.
1.Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions.
Before and after ethanol ablation of a massive benign cystic nodule
2.US-guided Radiofrequencythermal ablation RFA treatments may be considered for solid or mixed symptomatic benign thyroid nodules.
Typical 16 ml symptomatic benign thyroid nodule that can avoid surgery by being ablated by RFA.
Before and after RFA with 15 month follow up ultrasound.
3. Surgery remains the treatment of choice most malignant or suspicious nodules.
Comments: The use of PEI and RFA has expanded to include primary and recurrent papillary cancers. DR.G.
4. However, Both PEI and RFA have been used as alternative treatment for recurrent nodal neck metastatic from papillary carcinoma.
Mayo Clinic’s Ian Hay says ethanol ablation of up to 5 recurrent cancer lymph nodes and be treated without another costly neck dissection. Each lymph node ablated saved thousands in surgical costs.
5. Recent addition of active surveillance AS for small micro-papillary <1.5 cm as alternative to surgery has prompted both PEI, and RFA added as a third option for those who don’t want surgery or AS.
<1.5 cm micro-papillary cancer can be ablated by ethanol as shown by
a study shown by DR.Hay.
DR HJ Baek working in Seoul Korea has used RFA to successfully
4. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
Ethanol ablation is available in my center, and RFA needs candidate referral to Korea.
For both procedures call Matt at 310-393-8860 or [email protected] for details.
Richard guttler MD,FACE,ECNU