Contemporary Thyroid Nodule and Cancer Treatment: The New Age of Minimally Invasive Treatment.
In the paper a Flow sheet for nodules includes a section on compressive and cosmetic symptoms.
Treatment Pre Ablation option: Surgery
Modern minimally invasive Treatment with thermal ablation:
Radiofrequency Ablation RFA with the preferred method of compared to Laser LA,
microwave MWA, or High intensity focused ultrasound HIFU.
- Ethanol Ablation PEI
- Mechanism: dehydration of cytoplasmic proteins and fibrosis.
- Which nodules? Cystic or mainly cystic thyroid nodules. Parathyroid cysts. Thyroglossal duct cysts. Metastatic lateral neck papillary cancer lymph nodes recurrent after thyroidectomy and radioiodine therapy S/P neck dissections.
- Expected results? 60 % volume reduction for cysts. Complete ablation of neck cancer lymph nodes. PI can replace surgery after failed prior neck dissections.
- Adverse effects? pain, burning sensation, hematoma, dyspnea, and voice change.
- Complication rate? 0%
- Cost estimates: $750-3000.
- Radiofrequency Ablation RFA
- How it works: heat coagulation necrosis.
- Who are candidates for RFA? Mixed or sold nodules, Autonomous functioning thyroid nodules AFTN, toxic nodules, micropapilary thyroid cancer, parathyroid adenoma, metastatic cancer lymph nodes, Neck cysts ( Thyroglossal duct cysts).
- Expected results? 48-97 % reduction of nodules. Return to nodule TSH function in AFTN and toxic nodules, complete ablation of micropapillary and lymph node metastatic disease, normal parathyroid function after RFA for parathyroid adenoma,
- Complication rate? 2 % overall and 1% major.
- Major: voice change, nodule rupture,hypothyroidism, brachial plexus injury.
- Minor: pain, fever, skin burn, hematoma, transient thyroiditis, transient hyperthyroidism.
- Cost estimates: Equipment $35,000-40,000. $6000-25,000 per session.
- In the USA FDA approved but there are no CPT codes for insurance billing. It is all out of pocket.Worth it to avoid a a full thyroid surgery in the hospital.
- Call Alicia at 310-393-8860 for details for any ethanol or RFA ablation evaluation. Also secure email to send records to [email protected]
- Reference: Contemporary Thyroid Nodule Evaluation and Management: A Review G. Grani et al J Clin Endocrinol Metab, September 2020 105(9):2869-83.