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.”