Contemporary Thyroid Nodule and Cancer Treatment: The New Age of Minimally Invasive Treatment.

Contemporary Thyroid Nodule and Cancer Treatment: The New Age of Minimally Invasive Treatment.

Contemporary Thyroid Nodule and Cancer Treatment: The New Age of Minimally Invasive Treatment.

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.

 

  1. Ethanol Ablation PEI
  2. Mechanism: dehydration of cytoplasmic proteins and fibrosis.
  3. 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.
  4. Expected results? 60 % volume reduction for cysts. Complete ablation of neck cancer lymph nodes. PI can replace surgery after failed prior neck dissections.
  5. Adverse effects? pain, burning sensation, hematoma, dyspnea, and voice change.
  6. Complication rate? 0%
  7. Cost estimates: $750-3000.
  8. Radiofrequency Ablation RFA
  9. How it works: heat coagulation necrosis.
  10. 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).
  11. 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,
  12. Complication rate? 2 % overall and 1% major.
  13. Major: voice change, nodule rupture,hypothyroidism, brachial plexus injury.
  14. Minor: pain, fever, skin burn, hematoma, transient thyroiditis, transient hyperthyroidism.
  15. Cost estimates: Equipment $35,000-40,000. $6000-25,000 per session.
  16. 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.
  17. Call Alicia at 310-393-8860 for details for any ethanol or RFA ablation evaluation. Also secure email to send records to [email protected]
  18. Dr.G.
  19. Reference: Contemporary Thyroid Nodule Evaluation and Management:  A Review                                               G. Grani et al J Clin Endocrinol Metab, September 2020 105(9):2869-83.
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