Different from other nodules these start as a single cloned cell that keeps growing until
there is enough to produce subclinical hyperthyroidism 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 Toxic Nodular Goiter. You can have one single AFT or toxic nodule or multiple AFTN or toxic nodules.
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 in red 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. Emotional problems, depression, Osteoporosis, and heart problems occur in elderly patients. This is masked or apathetic hyperthyroidism. Early treatment while still AFTN and full blown toxic nodule with hyperthyroidism are in need of treatment.
FOUR TREATMENTS FOR AFTN AND TNG ARE:
- 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 hang over, post op fatigue, and possible hospital infections. Removal of a lobe or more can leave you hypothyroid needing lifetime thyroid hormone replacement therapy. 30% with just a lobe need thyroid hormone for life.
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 in your home 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 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.
Although the majority of radiation goes to the overactive toxic nodule you can see smaller amount or radiation uptake in the rest of the gland
3. Thyroid Ablation Procedure:
A minimally invasive thyroid RFA treatment in Korea.
RFA will never cause hypothyroidism, and have lower complication rates than surgery. Thyroid RFA carry no mutation risks in the future like radioiodine therapy.
The main problem is in some the failure to kill every single cell clone.
RFA has more tendency to cause recurrence compared to surgery or Radioiodine. As multiple sessions may be needed to kill all the cloned cells in the AFTN or toxic nodule. Expert interventional radiologist in Korea has success with the treatment of AFTN or Toxic nodules with thyroid RFA.
Minimally invasive RFA thyroid probe in the toxic nodule. The right shows a thyroid probe made in Korea with small needle size and short probe.
Actual patient with AFTN before and after that was treated in Korea with Thyroid RFA.
Above minimally invasive RFA thyroid probe in the toxic nodule. The right shows a thyroid probe made in Korea with small needle size and short probe.
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 will never cause hypothyroidism, and have lower complication rates than surgery, but has more tendency to recur or need more sessions.
Pick your treatment based on these criteria.
Call Alicia for details about RFA if you are thinking of avoiding surgery or radiation.
1-310-393-8860 or email to [email protected]