What Is Interventional Thyroidology?

Interventional thyroidology is an emerging field that uses percutaneous (i.e. through the skin), image-guided procedures to treat thyroid diseases. Interventional thyroidology uses less invasive techniques, often a simple needle stick, than surgeries which often treat these conditions.

The most commonly performed procedures include ultrasound-guided ethanol ablation and ultrasound-guided radiofrequency ablation (RFA) of specific types of benign thyroid nodules, lymph nodes with recurrent thyroid cancer, and micro-papillary thyroid cancer.

Who Performs the Procedures?

Many different types of specialists can perform interventional endocrinology procedures including endocrinologists. Specialized training is needed perform RFA and PEI safely and with good results.

I have been training endocrinologists in interventional procedures for many years and now add thyroid RFA to PEI in my one on one private 2 day master’s class and workshop. This concludes with observation of a RFA and PEI treatment of my patients..

What Is Ultrasound-guided Ethanol Ablation PEI?

Ultrasound-guided ethanol ablation uses high-resolution ultrasound to guide the injection of a small amount of ethanol into a thyroid nodule or lymph node. The ethanol causes an inflammatory response that leads to very targeted destruction of the nodule or node.

This procedure has been very successful for treating cystic (fluid-filled) thyroid nodules, since simple cysts are almost never cancer (<1 percent) and partially cystic nodules with no suspicious features that have a very low risk of cancer (< 3 percent risk of malignancy).

Treatment of thyroid cysts is considered when compressive symptoms are present (i.e. difficulty swallowing, difficulty breathing, or voice changes) or when the cyst is very large.

Needle aspiration has a high chance of the cyst coming back (60-90%).

Surgery cures the problem, but it can be associated with a low risk of complications and some patients may not be able to have surgery due to other medical conditions.

Ultrasound-guided ethanol ablation is the treatment of choice for thyroid and parathyroid cysts.

What Is Ultrasound-guided Thyroid Radiofrequency Ablation (RFA)?

Radiofrequency ablation uses a small needle that creates very precise radio waves that heat up and destroy a small area of tissue.

RFA of thyroid tissue has been performed since 2002 and is best used in cases of recurrent thyroid cancer where surgery is not ideal, or symptomatic benign thyroid nodules.

How Can Interventional thyroidology Help with Recurrent Thyroid Cancer?

Although the overall survival for patients with thyroid cancer is excellent, up to 20% of patients will have recurrent disease (i.e. cancer that comes back) even with appropriate initial surgical treatment. The vast majority of these recurrences are found in the lymph nodes (90%).

Although surgery remains the preferred treatment for recurrent disease, the chance of complications increases because of the scar tissue created in previous operations.

Both ultrasound-guided ethanol and radiofrequency ablation have proven to be safe and effective procedures for recurrent thyroid cancer.

How and Where Are These Procedures Performed?

These procedures are are done in my office ultrasound room. 

The patient is given local anesthesia to skin and thyroid capsule.They are awake for the procedure.

Safely stopping any blood thinners or aspirin prior to the day of the procedure is needed.

Patients can eat normally up until the procedure and there are no restrictions.

Patients can resume normal activities the same day of their procedure.

What Complications Are Associated With The Procedures?

Like any other procedure, ultrasound-guided techniques can be associated with a small risk of potential complications. Most are minor. Major complication are rare.

 

Am I A Good Candidate For These Interventional Procedures?

If you are interested in either radiofrequency ablation or ethanol ablation and would like to see if you would be a good candidate, please contact me at 310-393-8860 or secure email at thyroid.manager@thyroid.com.

The Interventional program at Santa Monica Thyroid Center is a natural extension of my years of experience in neck ultrasound and thyroid biopsies and molecular marker testing. I trained ultrasound-guided interventional techniques with Roberto Valcavi in Italy and Leo Rangel in Brazil. I have spent 5 years working with three different RFA systems  and 20 years doing ethanol ablation. In Brazil I did my first thyroid RFA on a patient of Dr.Rangel’s with him as the proctor.

Dr.Leo Rangel

Dr. Valcavi