Thyroid Nodules and Cancer 101: Does Size Matter? Yes, except when it does’t.

Dr.Guttler’s Comments:

Thyroid No Surgery for this large benign symptomatic thyroid nodule. Treated by ethanol ablation PEI.

Cyst fluid removed and ablation with ethanol. Thyroid gland left intact and no need for thyroid hormone for life!

1. The size of the nodule should not be a reason to operate. The old days of removal of all large nodules is over.
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3. Early Turkish treatment of a cyst.
4. There needs to be evidence of potential cancer by cytology and molecular markers.
5. This is another area where there is a de-escalation of thyroid  surgery as the main treatment for most larger nodules.
6. Incidence of Thyroid cancer or a benign nodule is similar in small and large nodules.
7. Even the surgeons realize their control of thyroid nodules is over.
8. No more choosing to remove large nodules as a cautionary move with out evidence of cancer risk  by cytology and molecular markers.
9. Surgery itself is associated with potential risks, including increased physical and psychological morbidity, as well as a heavier financial burden, compared with the alternative approach of close clinical follow-up of cytologically benign nodules.
10. Recent paper of 35 studies and 20,000 nodules and 7000 had benign cytology class II.
11.  Recommending surgical resection of large cytologically benign nodules due to perceived (but not actual) high false-negative rates is wrong.
12.  Surgeons should stopped recommending thyroidectomy for large cytologically being nodules based on size alone.”
13. Malignancies among indeterminate thyroid nodules were low-risk regardless of tumor size.
14.  Size should not be driving more aggressive diagnostic surgeries for cytologically indeterminate thyroid nodules.
15. Size does matter for symptomatic or cosmetic large nodules.
16. However even here the new ablation techniques of ethanol PEI or radiofrequency ablation RFA can be used in place of surgery in this group as well.
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18. Large benign symptomatic thyroid nodule before RFA.
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20. The dark areas are post ablation destruction of the nodule.
21. De-escalation away from more surgery applies to symptomatic benign large nodules now with minimally invasive ablation methods.
22. Size does not matter as cancer is not more common in large nodules, and we have new tools to treat symptomatic large benign nodules with PEI and RFA.
23. Call me at 310-393-8860 or [email protected] for ablation alternatives.
24. Save your thyroid!
25. Dr.G.