There are 4 Treatments for Toxic or Autonomous Thyroid Nodules:Only One Involves No Surgery or Radiation

There are 4 Treatments for Toxic or Autonomous Thyroid Nodules:Only One Involves No Surgery or Radiation

There are 4 Treatments for Toxic or Autonomous Thyroid Nodules:Only Two Involvee No Surgery or Radiation

What is a toxic nodule TNG or autonomous functioning thyroid nodule AFTN?


Different from other nodules these start as a single cloned cell that keeps growing until

there is enough to produce subclinical hyperthyroid with normal T4 but suppressed TSH.

This is AFTN.

This can last for years until the mass of cells can produce excessive thyroid hormone to raise the T4, and totally suppress TSH. This is overt hyperthyroid called TNG.

The disease is first noted by low TSH. This will be followed by ultrasound


A nodule is noted on US. This with the low TSH will trigger a

Iodine uptake and Image

Hot Nodule seen in RAI/131 image


There is a long period when the patient is in limbo.Not toxic yet but could be having

side effects from mild excess hormones suppressing the TSH ie Osteoporosis, heart problems. Early treatment while still AFTN is indicated.Full blown Toxic nodule with hyperthyroidism is in need of treatment.





  1. Surgical removal of the lobe with the hot nodule.



Thyroid surgery will cure the patient but comes with risks of complications.

Many low volume surgeons still do thyroid operations even though they do them with increased risks of nerve and calcium problems. If you opt for surgery make sure it is a high volume surgeon > 25/year with < 2 % complication risk. Also there is expense loss of work, anesthesia, post op fatigue, and possible hospital infections. Removal of a lobe or more can leave you hypothyroid needing lifetime thyroid hormone replacement therapy.


14 th century surgery was brutal but 21st century thyroid surgery in the wrong hands can also be unkind to the patient.

2. Radioiodine therapy.

Nuclear medicine will determine the dose of I/131 given. It is usually more than needed for Graves’ disease. You will have isolation protocol away from children and pregnant females for several days. Radiation can also make you hypothyroid and need lifetime replacement just the same as surgery.There is a small whole body radiation burden from radioiodine treatment that has a small  future risk of other cancers.

Image of before and after radioiodine 131 therapy for toxic nodule.





3. Thyroid Ablation Procedures:  Radiofrequency RFA and High Intensity

    Focused Ultrasound HIFU

Both are either minimally invasive RFA or non-invasive  HIFU

RFA and HIFU  will never cause hypothyroidism, and have lower complication rates than surgery. They carry no mutation risks in the future like radioiodine therapy.

The main problem is the ability to kill every single cell clone. That is why RFA and HIFU has more tendency to cause recurrence compared to surgery or Radioiodine.


Above minimally invasive RFA thyroid probe in the toxic nodule


HIFU ultrasound probe is placed on the neck not in the nodule. The company in Europe

that supplies systems in Europe and Asia but noot yet in the USA.



1. Surgery has more complications, but will cure you.It can leave you hypothyroid for life.

2. Radioiodine therapy with higher dose than for Graves’ disease, also can make you hypothyroid, and add radiation burden for future cancers.

3. RFA and HIFU will never cause hypothyroidism, and have lower complication rates than surgery, but has more tendency to recur.

Pick your treatment based on these criteria.

Call Matt for details about RFA and HIFU if you are thinking of avoiding surgery or radiation.


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