Benign Thyroid Nodules: Safe and Less Expensive Radiofrequency Ablation RFA Treatment in a Private Endocrinologist’s Office.
AACE National Meeting Washington DC on May 7-10 8 2020.
Thyroid RFA is a first line therapy for benign thyroid nodules. However most RFA procedures are done in the hospital or imaging centers by radiologists. As a clinicaI thyroidologist, I will present the results of thyroid RF treatment on 12 cases who had Thyroid RF in my medical practice. The procedure is safe and is done while the patient is awake.
Patients were vetted to be sure they had a low likelihood of having thyroid cancer. Ultrasound determined Volume of the target nodule was also done pre-RFA and after. Scores for symptoms and cosmetic problems were collected pre-RFA and after for 12 months. Except for local Lidocaine injection of the thyroid capsule there was no general or conscious sedation that is used in the hospital setting. A RF generator system ( RF Medical Korea) with short 7 cm # 18 gauge electrode with a 10 mm hot tip and cooling pump was used. The method of treatment was trans-isthmus approach and the moving shot technique under US guidance. The average time for the procedure was 30-45 minutes. 1,3,6,and 12 months followup ultrasounds were done with some still pending. Microdissection technique with dextrose infusion was used in some cases with a dangerous vital structure near the target nodule.
The nodules all decreased in size and the symptom and cosmetic scores improved by the sixth month post RF. Except for local pain after the procedure treated with Tylenol there were no complications. One patient needed a Medrol dose pack to help with her pain.The goal of Thyroid RF is to relieve symptoms and improve cosmetic problems not to make the nodules disappear. Aggressive approach leads to increased complications.
Thyroid RF is a procedure easily learned by AACE ECNU certified endocrinologists who do their own ultrasounds, biopsies and thyroid cyst PEI. With their vast knowledge of thyroid disease they seem to be the ideal operator for thyroid RF. There are teaching programs outside of the university systems that can be used to train endocrinologists. In conclusion this preliminary study of 12 patients shows how Thyroid RF can be safely done in the scope of a endocrine office practice.The cost for office based thyroid RF is less than hospital or imaging centers.There is no need for special operating room equipment and the small generator fits easily in the office ultrasound room. With no specific codes for thyroid RF the patient must pay out of pocket. Less costly Thyroid RF in their endocrinologist's office would be their best option. Endocrine office based fees are 3-5 times less costly than of hospital and imaging centers. Private endocrinologists can offer payment plans through outside medical loan companies to help the patient get treated. Endocrine societies should offer Thyroid RF training to interested thyroid orientated endocrinologists. At present there are few Thyroid RF training programs. There are several in Europe and Korea, but few in the USA. Here are your options to get the needed experience to be able to but a thyroid RF system. 1. A basic course which includes 2 days of lectures, hands on ablation workshop using bovine livers, followed by observation of expert interventional thyroidologist doing thyroid nodule cases.Call me for details of my basic course. 310-393-8860 or email to [email protected] DR.G. Recent master's class physician showing off her good RFA skills on a beef nodule. 2. Present your certificate of basic training to obtain your own system from RF Medical Korea to Rudy Garay at RGS HealthCare and begin your exploration of Thyroid RF by doing 30-50 bovine liver procedures. 3. When you feel comfortable doing models consider the next step. 4. Advanced training is available in Brazil with Dr.L.Rangel in Rio. He after one day of lectures you move to his hospital where he has permission to train outside specialists by under his direct supervision to treat thyroid nodules on his patients. I am doing a case in Rio in the advanced course of DR.Rangel's.