Voice Over for the Endocrinologist Office Based Thyroid Nodule Ablation Video

Voice Over for the Endocrinologist Office Based Thyroid Nodule Ablation Video

Voice Over for the Endocrinologist Office Based Thyroid Nodule Ablation Video

                                                      You Tube Video



                             The Voice Over for the RFA Thyroid Nodule Video  

I am Richard Guttler board certified endocrinologist, and clinical thyroidologist in private practice with special interest in non-invasive methods to decrease unnecessary thyroid surgery.Today I am showcasing thyroid radiofrequency ablation for benign thyroid nodules. This simple outpatient procedure is done in my office with no general anesthesia or conscience sedation, just a local.

  • The patients are selected for thyroid RF when they have a symptomatic benign nodule or a cosmetic They

need to have benign prior needle biopsies, normal thyroid tests, and clotting screen. A pre-RF image is taken of the neck.

  • The ultrasound is used to evaluate the nodule and to locate dangerous These include the vagus nerve, esophagus, trachea, carotid and the danger triangle with the recurrent nerve. Also it is used to make sure the electrode entry way is clear of blood vessels in the isthmus.


The RF room has a patient has a table,ultrasound,generator,ice water pump, and on /off foot pedal to control the hot tip. The generator has adjustable watt control, and there are 2 grounding pads to apply to the patients thighs. O2 sensor, BP and Pulse are monitored by my roving nurse. Standing emergency tray has iced saline for any voice changes, Tylenol for mild pain and anti-nausea medications. The adjustable watt control allows increases to better effect ablation or decreases to accommodate a patient compliant of some pain.


The RF System ( RF Medical Korea ) includes a generator, ice water pump, a power source off/on foot pedal, grounding pads, and the electrode.

  • The electrode is only 7 cm long and has a thin needle with a hot tip of 3-10  This is ideal for working in the small space of the neck. The ice water from the pump circulates around the needle to keep the rest of the electrode cool
  • The patient has their head in a donut at 6 degrees elevation, and has a blind fold or can elect to watch from an overhead I am at the head of the table facing the generator at the foot of the table. There are 2 screens and the Sonographer stands on the patients side and monitors the ultrasound, and the insertion direction of the electrode on one screen while I monitor the other screen and the generator.
  • My sonographer helps locate the best position in the nodule and after I am satisfied the location is safe, I activate the heat with the foot  When significant

ablation occurs I use the foot pedal to turn off the heat.

  • This is done over and over to different areas of the nodule until the total volume is 
  • My roving nurse is monitoring the patient’s voice and any symptoms during the  She also records vital

signs, and can on my directions adjust the wattage.


The superior and inferior extent of the nodule is marked with red marker on the patients neck. 

The midpoint of the nodule is marked with an X.

The X is the entry point for first the local injection of the skin, then thyroid capsule, the  cyst drainage if needed and then RF electrode.

  • The thyroid capsule has sensory nerves that can cause  I inject 1% lidocaine along the outside pericapsular space of the thyroid capsule before I start the ablation.
  • Also the cystic fluid if present is drained before the RF


The electrode is inserted through the isthmus in a direction away from the danger triangle. This is called trans-isthmic approach.

  • The procedure uses US guidance to position the electrode in a series of places in the nodule usually from inferior/posterior to inferior anterior in each section of the nodule during serial 10 mm ablation zones. This can usually take 30-45 min
  • US images show the area of ablation by hyper echoic echos whitish in  The electrode is then moved to a different area. Caution is taken to not get too near the

capsule while the electrode is activated.

  • The post RF US will show the areas in the nodule ablated by hyper echoic whitish pattern .
  • The patient is observed for 15-30 minutes and then returns to the examination room. Questions about how they felt during and if they have any side effects. A picture and a video of the neck is then taken.
  • The patient returns at 1, 3, 6, and 12 months for US and repeat symptom and cosmetic questionnaire and scores

to compare to the pre-RF score.

  • A well trained interventional endocrinologist is the best physician do the thyroid RF and it can be done without visiting a  hospital.


  • Thankyou
  • Ken MacLennan December 28, 2019 4:16 am

    Hi dr Guttler I talked to you about four years ago. I am ken from ontario canada.I have had the rfa done two times now and will going for my third treatment in the middle of january.I must congratulate on getting the word around about rfa.hopefuly the doctors in canada will wake up and start doing rfa of the throid noduals instead of cutting them out. perhaps in the furture one doctor will get trained for this procedure.Thanks for all the work you have done in this field. Ken

    • Dr Guttler January 14, 2020 12:51 pm

      Great news.
      Where did you go?
      Also I am doing RF now in the USA since 2019.
      Canadians don’t have to travel far now.
      Doing 2 from Canada next week.


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