Thyroid Nodules No Surgery: 3-5 years after Thyroid Ethanol PEI or Radiofrequency Ablation RFA.
1. Benign thyroid nodules in 2019 do not need to be treated by invasive thyroid surgery.
2. Cystic nodules > 50% fluid the treatment of choice is ethanol ablation PEI.
3. Solid nodules are treated by both PEI and RFA. RFA is the treatment of choice however as it causes the best decrease in size.
4. As a thyroidologist my goal is to relieve symptoms and correct any secondary cosmetic effect.
5. Therefore I pay attention more to correction of symptoms and any cosmetic issues.
6. The size of the nodule is important as smaller nodules can be symptom free but a residual nodule will still be present at 5 years.
7. Dramatic reduction of larger nodules may not be sustained at 5 years, and a second treatment may be needed only of symptoms or cosmetic problems recur.
8.My experience is with PEI and have sent patients out of the country for RFA.
9. Only one patient with a very large nodule needed 3 RFA treatments of 2 years.
10 Only a few PEI patients needed repeat during a 5 year period.
11. PEI is done in my office without local anesthesia and the time involved is 20-30 minutes. 200 proof medical grade ethanol is injected after draining the cyst fluid.The ethanol is removed after 3-5 minutes.The procedure is fast and safe and replaces the hospital based thyroid surgery.
12.RFA was performed after local anesthesia, under ultrasound guidance, by means of “moving-shot” technique and by using the trans-isthmic approach. The treatment time was 14-20 minutes. RFA system uses internally cooled 18-gauge electrode and with an active 10 mm tip.
13.Nodule volume and compressive and cosmetic concerns responded to RFA .
14. 215 patients were studied in a recent paper from Korea.
15.Reduction of nodule volume was found after one year, lasting up to five years.
16. Nodules showed a reduction of about 67%%
17. The best volume response after five years (82%) was observed in nodules with a volume below 10 mL at baseline.
18. Patients’ symptoms were significantly reduced.
19. A durable shrinkage of benign thyroid nodules treated by RFA, as well as an improvement of compressive and visual symptoms occurred at 3-5 years.
20.The reliability of RFA and ethanol PEI makes them great alternatives to surgery in the management of thyroid nodules.
21. These remarkable therapeutic tools for clinical practice are available at my center.
Call 310-393-8860 or [email protected] details how to avoid thyroid surgery with these two procedures.
22. Ethanol for cystic masses including parathyroid cysts, thyroglossal duct cysts, recurrent thyroid cancer neck lymph nodes and primary micropapillary cancer.
23.Micropapillary cancers that are very low risk can be treated with observation or ablation procedures with PEI or RFA instead of lobectomy in the hospital.
24. These small cancers may be better called low risk tumors and avoid the word cancer.