Thyroid Ablation 101: What to do about a massive goiter in a patient unable to have surgery due to severe lung disease ?
CD a 30 Y/O F in a wheelchair has onset of choking for one year but an untreated enlarging goiter for at least 10 years. She was from a small town and did not see an endocrinologist but primary and local surgeons failed to tell her guardian that there was alternative therapy if she traveled to a major center. They found me on line.
Evaluation at my center found a fixed neck with no movement with swallowing. The goiter was too large for Ultrasound sizing. However, there was 3 significant large cystic areas.After a biopsy of a suspicious 4 cm nodule, with the help of Matt Foss and Dr.Flower Mai, visiting endocrinologist taking my ablation master’s class I did ethanol ablation of the cyst component with the hope of improving her symptoms until she could fly to Korea for definitive RFA treatment with Dr.JH Baek at Asan Medical Center in Seoul.
Video of frozen neck
CT of massive goiter with a 4-10 mm trachea compression.
PEI was done under US imaging and after removal of 55 cc brown fluid. 22 cc of 200 proof ethanol was injected,washed in and out multiple times before removing all the ethanol..
Her Post PEI neck image was smaller and it now moved slightly with swallowing.
Follow up phone call 3 days later she said others noted it was smaller and she stated ” I have an easier time swallowing”.
Comments: These type of cases with many reasons not to have surgery should not be allowed to suffer when methods are available to treat them without surgery.
Call me and talk to Matt for an evaluation for PEI or RFA details.
310-393-8860 or emal at [email protected]
Richard Guttler MD,FACE,ECNU
Interventional Ablation Thyroidologist.