Thyroid No Surgery 101: The days of all thyroid cancers going to the surgeon to have their thyroid removed is over.
Case: A 35 Y/O male has evaluated for enlarged neck lymph nodes and during the evaluation a neck ultrasound found 2 micro nodules and one cystic solid larger nodule. the large nodule was a benign class II nodule. The 2 4 mm nodules were micro-papillary cancers. FNA of the lateral neck nodes were inflammatory. He was referred for surgery, but questioned the need for surgery with such tiny cancer micronodules to his endocrinologist,primary and surgeon. With no alternative methods even suggested he googled ” Thyroid RFA for thyroid microcancers” He found thyroidnosurgery.com and came for a third opinion. The larger nodule was benihn and without symptoms or cosmetic problems it did not need surgery. The two confirmed micropapillary cancers one in each thyroid lobe could be ablated with RFA. Two sessions would be needed as the cancer were on different lobes.
Why few physicians rarely consider Thyroid RFA for anything is amazing to me with almost 20 years since it was developed in Korea. Finally in 2019 it was FDA approved for soft tissue ablations including thyroid.
1. There are at least two proven non-surgical methods to treat very small papillary thyroid cancers without surgery.
2. Tumors less than 1.5 cm called micro-papillary cancers can be followed without surgery. this is called active surveillance. Frequent neck ultrasounds to determine if the tumor is growing can find the case with nodule growth. A “rescue” surgery is just as successful as one done at the beginning. Many cancers do not grow. The drawback is many patients are not happy leaving a cancer in their neck even though it is a relatively safe way to treat micro-papillary cancers.
3. A third alternative which is gaining popularity with patients is the use of radiofrequency ablation RFA followed by a repeat biopsy after to confirm the cancer is ablated. This is a safe easy way to remove the cancer with low complication rates. Special electrodes are built just for the thyroid that have thin #19 gauge short (7 cm)electrodes with a very small hot tip (5 mm) just for micro-lesions like lymph nodes, micropapillary and parathyroid adenomas.
4. The patient usually has run the gauntlet from primary to radiology for biopsy to endocrinologist and then to the surgeon.They all agree the patient needs surgery. No one recommends alternative therapy with RFA. Some suggest active surveillance. The patient is confused and opts for the surgery.
5. How do you find an interventional thyroidologist doing RFA and ethanol ablations?
6. If you search Google for one you will find me and my center.I have posted videos of the RFA and ethanol ablation procedures done in my office without general or conscious sedation only lidocaine local.My thyroid blog has a section on RFA and one on ethanol ablation.
7. Before heading off to the hospital call me for my opinion if Thyroid RFA is right for you.
310-393-8860 or secure email to [email protected]
Ask for Alicia