Thyroid Radiofrequency for Thyroid Cancer and Nodules: Another reason for the FDA to stop stone walling ThyroidRF and approve it because we are are still one of the few countries without Thyroid RF.
Thyroid RF for can be used to ablate thyroid remnant post thyroidectomy. This can reduce the amount of radioiodine needed compqared to when no Thyroid RF is used before the RAI/131.
Radiofrequency ablation for postsurgical thyroid removal of differentiated thyroid carcinoma
This study evaluated the clinical values of radiofrequency ablation (RFA) in the postsurgical thyroid removal for DTC.
35 DTC patients who had been treated by subtotal thyroidectomy received RFA for postsurgical thyroid removal. Before and two weeks after RFA, the thyroid was examined by ultrasonography and 99mTcO4 – thyroid imaging, and the serum levels of free triiodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) were detected. The efficacy and complications of RFA were evaluated. Results showed that, the postsurgical thyroid removal by RFA was successfully performed in 35 patients, with no significant complication. After RFA, the average largest diameter and volume were significantly decreased in 35 patients (P > 0.05), and no obvious contrast media was observed in ablation area in the majority of patients. After RFA, the serum FT3, FT4 and Tg levels were markedly decreased (P < 0.05), and TSH level was significantly increased (P < 0.05). After RFA, radioiodine concentration in the ablation area was significantly reduced in the majority of patients. The reduction rate of thyroid update was 0.69±0.20%. DTC staging and interval between surgery and RFA had negative correlation (Pearson coefficient = -0.543; P = 0.001), with no obvious correlation among others influential factors. RFA is an effective and safe method for postsurgical thyroid removal of DTC.
Under guidance with Logiq E9 ultrasound machine with 6-16 MHz linear probe (GE Healthcare Inc., WS, USA), the RFA was performed in an outpatient operating room by 2 ultrasound intervention doctors with 5 years of RFA experience. Radiofrequency generator (VRS01, STARmed Inc., Gyeonggi-do, Korea) and thyroid-dedicated, internally cooled radiofrequency electrode (STARmed Inc., Gyeonggi-do, Korea) were used for ablation. A 7-cm long, 18-gauge electrode with a 0.5- or 1.0-cm active tip was chosen according to postsurgical thyroid size. The radiofrequency power was 20-45 w, and the radiofrequency work time was 1.0-4.5 min. The patient blood pressure, blood O2 saturation, heart rate and electrocardiography were monitored during the RFA procedure.
The patient was in supine position, with pillow under shoulder and head back to expose the neck. After iodophor disinfection and sterile towel, lidocaine (2%, up to 10 mL; Hebei Tiancheng Pharmaceutical Co., Ltd., Shijiazhuang, China) we carefully injected to the skin, needle track and anterior thyroid capsule for local anesthesia. Several important methods were performed to prevent the unnecessary compliances during RFA. Firstly, US-guidance was used to trace the electrode tip. Secondly, totally 20-30 mL of physiological saline (North China Pharmaceutical Co., Ltd., Shijiazhuang, China) was injected to front edge of residual thyroid tissue, inner carotid sheath and back of thyroid gland to create a protective barrier to radiofrequency energy (i.e., the hydrodissection technique).
All 35 patients successfully received the post-surgical thyroid removal by RFA, including 25 cases of unilateral postsurgical thyroid removal (left, 11 cases; right 14 cases) and 10 cases of bilateral postsurgical thyroid removal for in patients. The mean time of hospitalization for all patients was 1.2 days.
There was no significant complication for the RFA procedure. Two patients experienced voice change immediately after RFA and recovered soon.A burning sensation, pain, or both came from 10 patients, but the symptoms were relieved by reducing RF power or stopping RFA procedure for several seconds.
Ultrasonography examination results
Routine ultrasonography showed that, before RFA, there were low-level echo and relatively rich blood flow signal in thyroid tissue (Figure 1A, ,1B).1B). After RFA, the high-level internal echo with light spots in the ablation area was observed, without obvious color flow inside (Figure 1C, ,1D1D).
CEUS showed that, before RFA, there were irregular enhancement in the whole residual thyroid tissue (Figure 2A); After RFA, no obvious contrast media was observed in the ablation area in 34 patients (Figure 2B), with contrast media filling in 1 patient. The second RFA was executed for this patient, and the active ablation time was 45 s. The CEUS was performed again, until no obvious contrast media was observed.
Changes of radioiodine concentration in thyroid
99mTcO4 – thyroid nuclear medical imaging showed that, before RFA, there was obvious radioiodine concentration in thyroid, which indicated the residual thyroid tissue. After RFA, radioiodine concentration in the ablation area was significantly reduced, the reduction rate of thyroid update was 0.69±0.20% (Figure 3). Only for 2 patients, the reduction rate of thyroid uptake was 0.4%, others were more than 0.5%. In addition, the Tg levels of these 2 patients were 2.31 and 1.76 ng/mL, respectively. Therefore, two radiologists gave the final conclusion that all 35 patients could receive the radioactive iodine treatment.
Two ways for removal of residual thyroid tissue after surgery. One is secondary surgical removal, and the other is radioactive iodine treatment.
There are many significant complications for repeated surgical therapy, including nerve injury, hypoparathyroidism and cosmetic concerns rated to re-incision.
Although the radioactive iodine thyroid removal is the most common treatment method in clinic, but the efficacy depends on many influential factors. This treatment is also associated with many complications. In this study, RFA is used for postsurgical thyroid removal of DTC. All 35 patients have successfully received RFA, and obtained satisfactory efficacy. After RFA, the maximum diameter and volume of residual thyroid tissue are decreased slightly. The serum FT3, FT4 and Tg level significantly drop down in the majority of patients, and the TSH level markedly increases.
In this study, RFA was performed in the patients who require radioactive iodine treatment after thyroid surgery.
In conclusion, RFA is the effective and safe method for postsurgical thyroid removal of DTC. This study has provided a basis for further application of RFA to treatment of thyroid carcinoma.
Get mad as hell and send letters to the FDA to approve Thyroid friendly RF systems from Korea without further delaying tactics.
Richard Guttler MD,FACE,ECNU
Call me to find out you can go to Korea for thyroid RF for your thyroid nodules and cancer.
1-310-393-8860 0r [email protected]