No Country for Aggressive Operators: Do No Harm When Treating Thyroid Patients with Radiofrequency Ablation RFA

No Country for Aggressive Operators: Do No Harm When Treating Thyroid Patients with Radiofrequency Ablation RFA

No Country for Aggressive Operators: Do No Harm When Treating Thyroid Patients with Radiofrequency Ablation RFA

No Country for Aggressive Operators: Do No Harm When Treating Patients with Benign Thyroid nodule  with Radiofrequency Ablation RFA.

  1. It takes years of experience to go for total ablation of large thyroid nodules.
  2. The risk of injury increases with this “John Wayne” attitude.
  3. Vast majority of patient will be happy with relief of symptoms and cosmetic issues with partial reduction of the nodule.
  4. To improve results and prevent complications the operator must do a risk assessment history and ultrasound.
  5. What is risk assessment?
  6. Check history for other diseases such as obesity, hypertension, heart, and Diabetes take could cause increased risk during the ablation.
  7. Prepare an ultrasound risk assessment before the therapy.
  8.  Nodule Location
  9. Grade 0 Nodule is located in the thyroid gland away  >2 mm from dangerous structures.
  10. Grade 1 Medium risk nodule distance is <2 mm from carotid sheath, anterior or posterior cervical muscles.
  11. Grade 2 High Risk Distance of nodule from trachea, esophagus, or recurrent nerve is <2 mm.
  12. Grade 3 Very High Risk Both grade 1 and 2 existed.
  13. Make a patient score sheet with data from the evaluation with your plan to safely treat the benign nodule?
  14. What is the plan when you treat small recurrent thyroid cancers that are near the recurrent nerve and carotid sheath?
  15. Small micropapillary thyroid cancer can be ablated if the location is a safe place to do a total ablation. Again use of iced dextrose and hydrodissection can be helpful.
  16. Total ablation requires the use of iced dextrose to be used to treat the voice changes that could occur for rapid reversal of the voice change.
  17. Finally parathyroid adenoma is another problem for total ablation. The location is high risk and total ablation is usually the treatment of choice. One must be able to use hydrodissection and iced dextrose to prevent injury as needed.
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