Dr.Guttler’s #10 Patient Thyroid Blog: The Surgeons Are Removing To Many Thyroid Glands in Patients with Benign Thyroid Nodules.

Dr.Guttler’s #10 Patient Thyroid Blog: The Surgeons Are Removing To Many Thyroid Glands in Patients with Benign Thyroid Nodules.

Dr.Guttler’s comments

The only way to stop you from losing your thyroid for no reason is to insist evaluation for alternative therapy with thyroid radiofrequency ablation RFA. Read this paper on excess thyroid surgery for benign nodules by Kim et al.

1. Patients were considered potentially eligible for radiofrequency ablation if they had a dominant nodule >2 cm with or without compression symptoms, a dominant nodule <2 cm with compression symptoms, or a toxic adenoma.

2. 411 surgery patients in total, 284 (69.1%) would be eligible to consider thyroid radiofrequency ablation.

3.At surgery in the radiofrequency ablation–eligible group, 20 (7.0%) experienced voice change after surgery, and 2 (0.7%) were dissatisfied or concerned about their scar. 

4. In the radiofrequency ablation–eligible group, 70/284 patients (24.6%) had malignancy diagnosed by final pathology. 47/70 were small low risk <1 cm micro-papillary cancers.

5. However there were 23 /284 patients (8.1%) had cancers that were equal to or larger than 1 cm in size.

6.The rate of occult malignancy, optimal evaluation of non-dominant nodules before radiofrequency ablation is essential.

7. Long-term thyroid surveillance should be considered for patients with multiple nodular goiters  who undergo radiofrequency ablation.

8. Call me at 310-393-8860 or email to thyroid.manager@thyroid.com for a consult before the surgery.

Ask for Alicia.

Dr.G.

Elsevier

Surgery

Volume 171, Issue 1, January 2022, Pages 160-164

Surgery

Thyroid

Implications of radiofrequency ablation in patients undergoing thyroid surgery for benign disease in the United States

This study was accepted for an oral podium presentation at the American Association of Endocrine Surgeons 41st Annual Meeting, April 25–27, 2021.

Wen T.ShenMDcJessica E.GosnellMDcSanziana A.RomanMDcJulie A.SosaMD, MAcQuan-YangDuhMDcInsooSuhMDe

https://doi.org/10.1016/j.surg.2021.04.054Get rights and content

Abstract

Background

Radiofrequency ablation is an alternative strategy for the management of benign thyroid conditions. We analyzed the proportion of patients who underwent thyroid surgery for benign conditions who would be potentially eligible for radiofrequency ablation.

Methods

We identified patients who underwent thyroid surgery from 2015 to 2019 at the study institution for Bethesda II cytopathology or toxic adenoma. Patients were considered potentially eligible for radiofrequency ablation if they had a dominant nodule >2 cm with or without compression symptoms, a dominant nodule <2 cm with compression symptoms, or a toxic adenoma.

Results

Of 411 patients in total, 284 (69.1%) would be eligible to consider thyroid radiofrequency ablation. In the radiofrequency ablation–eligible group, 20 (7.0%) experienced voice change after surgery, and 2 (0.7%) were dissatisfied or concerned about their scar. In the radiofrequency ablation–eligible group, 70 patients (24.6%) had malignancy diagnosed by final pathology, and 23 patients (8.1%) had cancers that were equal to or larger than 1 cm in size.

Conclusion

Many patients who undergo surgery for benign thyroid disease could be considered for radiofrequency ablation as an alternative treatment modality. Given the rate of occult malignancy, optimal evaluation of nondominant nodules before radiofrequency ablation and long-term thyroid surveillance for patients who undergo radiofrequency ablation should be further studied.

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