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The American Thyroid Association Statement on Ablation Techniques for Benign Thyroid Nodules recently published a thorough article that outlines implementation, qualification, methodology, and protocols for optimizing safety for the introduction of thermal ablation in clinical practice. This is an essential reference for all physicians hoping to embark upon interventional thyroid procedures. The endorsement of the American Association of Endocrine Surgery, American Academy of Otolaryngology, Head and Neck Surgery, American Head and Neck Society, Society of Interventional Radiology, Latin-American Thyroid Society, Asia and Oceania Thyroid Association, and Asia Pacific Society of Thyroid Surgery indicate the intense scrutiny assigned to this important reference and the broad scope of subspecialties it affects. The collective effort addresses nuances, highlighting the complexity of care associated with thyroid nodule management. The article clearly demonstrates the considerations and complexities of patient evaluation, pre-procedural planning, patient treatment, and post-procedural management. This enthusiastic effort is presented in the interest for our patients whom have experienced overwhelmingly positive results with this treatment modality. The full article is available for download.

Dr. Richard Harding is an expert in thyroid care, with 28 years of experience in evaluating and removing hundreds of thyroid glands per year. He is proud to offer RFA as a safe and effective option for his patients with benign thyroid nodules. RFA, or Radiofrequency ablation, is a non-surgical treatment that can transform the lives of people with large benign thyroid nodules. It uses internal energy to target and destroy the unwanted tissue, while preserving the healthy outer thyroid gland and its function. Success Stories RFA has many advantages over conventional surgery or RAI, such as lower risk of primary hypothyroidism (low thyroid hormone), faster recovery, and no scarring. Testimonials Our patients are very happy with the results of the RFA procedure, which allows them to avoid thyroid surgery and its complications. They can go home right after the treatment and resume their normal activities. Read More ​Success Stories ​Testimonials ​About Dr. Richard Harding ​Frequently Asked Questions

The treatment of these thyroid nodules varies on the nature of the nodules as well as the symptoms produced. Any malignancy will need to be removed if it is over 15 mm. Some smaller malignancies are now being followed without surgery. These are followed utilizing strict criteria and under research-based protocols. The success of this non-operative surveillance of small cancers has been very successful. Small nodules tend not to create symptoms, whereas large nodules can create many problems such as difficulty with breathing when laying flat, difficulty with swallowing solid food (pills), and even a chronic cough. Nodules with compression symptoms can be removed with surgery. If they are not cancer and not suspicious for the possibility of cancer, than a minimally invasive, ultrasound guided therapy can effectively destroy the nodule. This treatment applies energy directly to heat it up to the point of tissue death. Once the tissue is devitalized, the body walls off and slowly reabsorbs the treated tissue. This method leaves the adjacent normal tissue unharmed and thus preserves the thyroid function. Unfortunately, with surgery the entire side (lobe) is generally removed due to safety concerns. This unavoidably removes the abnormal and normal tissue on the entire side. Approximately 60-75% of these patients will require thyroid hormone supplementation. If a biopsy raises a concern for the possibility of cancer, then surgery is recommended to allow for proper analysis of the tissue by pathologist. The surgery should be performed by a surgeon very familiar with thyroid operations, and who performs them regularly. The definition of a high- volume thyroid surgeon is currently established at 25 operations annually. The Thyroid Nodule Treatment Center is available to navigate the numerous diagnostic and therapeutic options with you. Patients with normal thyroid function and who are symptomatic from large thyroid nodules can present immediately to review treatment options. This includes large visible nodules which are cosmetically distracting. The most innovative therapy may be available to you. International studies demonstrate excellent immediate and long- term results with radiofrequency ablation. A list of expert endocrinologists will be provided for those patients who have a complex endocrine history and require further evaluation, and long term care.

Dr. Richard J Harding has been evaluating and removing hundreds of thyroid glands per year for the past twenty years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. The benefits are the elimination of the symptoms from the large nodule and preservation of thyroid function. Many people have inquired about simply removing only the symptomatic nodule during surgery and leaving the residual healthy thyroid tissue. From the surgical perspective, this would cause complications including bleeding during and after surgery. Additionally, the way the body would respond to this type of procedure could create more problems than it solves. For this reason the removal of the entire thyroid lobe is generally advised. With this new Radiofrequency technique, the energy can be applied under precise ultrasound guidance and the damage to the healthy tissue is minimized. The functioning thyroid lobe is preserved, the thyroid nodule shrinks in size, and the main objectives are accomplished. Radiofrequency energy is currently being utilized for many tissue types in the body including veins, nerves, liver, and kidneys. The use of radiofrequency in thyroid nodules has been utilized in Korea since 2002. The Korean and Italian protocols for use with benign thyroid disease has been studied internationally such that entire protocols are accepted for safe and effective therapies. For this very reason this technique has spread around the globe, only to be recently approved in the United States by the FDA in late 2018. Currently there are very few providers in the United States who perform this technique. Many people have been traveling to Italy and Korea to have their nodules treated. This is no longer necessary as the procedure can be performed in my surgical office. Patients who have thyroid nodule symptoms will receive a comprehensive evaluation including neck ultrasound, ultrasound guided biopsies, and thyroid nodule radiofrequency ablation in one location. In order to be a candidate for the radiofrequency ablation, a patient needs two sequential biopsies to prove that they do not have a thyroid cancer. Those who are not candidates for this procedure of course will have the opportunity to discuss other surgical options available to them. Currently the evaluation of the thyroid nodules is covered by insurance companies, however the radiofrequency ablation of thyroid nodules is not considered a recognized benefit. We are hopeful this will change as more surgeons and endocrinologists establish more experience with this technique and both the healthcare community and patients advocate for the non-surgical solution to the treatment of benign thyroid nodules.

What is the difference between a patient's experience with thyroid surgery vs. thyroid Radiofrequency ablation (RFA)? Dr. Richard Harding explains the process in this video: Radiofrequency ablation (RFA) is a minimally invasive technique that uses heat to destroy benign thyroid nodules. It has been widely used in Asia and Europe for over a decade, and it is now gaining popularity in the United States. RFA has several advantages over surgery, such as preserving the normal thyroid function, avoiding surgical scars and complications, reducing the cost and recovery time, and improving the cosmetic outcome. RFA uses a thin needle electrode that is inserted into the nodule under ultrasound guidance. A high-frequency electric current is then passed through the electrode, creating heat that destroys the nodule tissue. The procedure is performed under local anesthesia and takes about 15 to 30 minutes per nodule. The patient can go home the same day and resume normal activities within a few days. The nodule size and symptoms usually decrease significantly within a few months after RFA. RFA is suitable for patients who have benign thyroid nodules that cause pressure symptoms, such as difficulty swallowing, breathing, or speaking, or that are cosmetically bothersome. RFA can also be used for patients who have recurrent nodules after surgery or who are not good candidates for surgery due to medical conditions or personal preference. RFA is not recommended for patients who have malignant or suspicious nodules, as they may require complete removal of the thyroid gland and lymph nodes. RFA is a safe and effective alternative to surgery for benign thyroid nodules. It has been shown to reduce the nodule volume by 50% to 90%, improve the quality of life and satisfaction of patients, and have a low complication rate of less than 1%. If you are interested in learning more about RFA or scheduling a consultation, please contact us today.

Save Your Thyroid! The benefits of Radiofrequency Ablation Treatment (RFA) are the elimination of the symptoms by shrinking the large nodule while preserving thyroid function. Eliminate Compression Symptoms Shrink Thyroid Nodules No Incision or Scarring Preserve Thyroid Function Nonsurgical Alternative to Thyroidectomy Eliminate Toxic Thyroid Nodules Over the years many people have inquired about simply removing just the symptomatic nodules and leaving the residual healthy thyroid tissue during a thyroid operation. Although the concept is relevant, the attempt to perform this type of operation would lead to complications such as bleeding during and after surgery. The healing process to this complex procedure would create more problems than it solves. For this reason the removal of the entire thyroid lobe is always advised. However, with this new minimally invasive Radiofrequency technique, the energy can be applied under precise ultrasound guidance. The injury to the healthy tissue is minimized. Post procedure scarring, discomfort, and bleeding is minimal. The normal functioning thyroid lobe is preserved while the thyroid nodule shrinks in size over a short period of time. The objectives are accomplished through a pinhole incision under local anesthesia Advantages of RFA treatment RFA is relatively painless RFA does not require general anesthesia. RFA is a non-surgical alternative to thyroidectomy and radio-iodine ablation The procedure itself takes less than an hour, the entire process may take 2-3 hours. Compared with surgery, the primary advantages of radiofrequency ablation are: Increased likelihood of preservation of thyroid function. The potential of fewer complications. Generally shorter recovery time with a quick return to normal activities Radiofrequency ablation may also minimize the risk of permanent damage to the vocal cord nerve or to the parathyroid glands Because it is minimally invasive and does not require general anesthesia, you avoid the external scarring of traditional thyroid surgery, and the associated risks of anesthesia. The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain. Other than the initial injection of numbing medication, the only remaining sensation is generally pressure Intermittent sensations of discomfort thereafter can be treated with additional doses of pain medication or adjustment of the probe tip. Often, difficulty swallowing, feelings of pressure or tightness of the throat, or even the bulky appearance of the nodule is usually significantly decreased or no longer detectable.

The research is a systematic review and meta-analysis of studies that evaluated the long-term results of thermal ablation of benign thyroid nodules. Thermal ablation is a minimally invasive technique that uses heat to destroy abnormal thyroid tissue. The research compared two types of thermal ablation: radiofrequency ablation (RFA) and laser ablation (LA). The research included 14 studies with a total of 1,434 patients who underwent thermal ablation and had follow-up data of more than 3 years. The research found that thermal ablation was safe and effective for reducing the volume of benign thyroid nodules, with no unexpected delayed complications. The research also found that RFA was superior to laser ablation (LA) in terms of volume reduction rate, regrowth rate, and delayed surgery rate. The research concluded that thermal ablation (RFA) is a viable option for treating benign thyroid nodules. Read the full research. Visit Resources for more research downloads.

RFA is relatively painless RFA does not require general anesthesia. RFA is a non-surgical alternative to thyroidectomy and radio-iodine ablation. Increased likelihood of preservation of thyroid function. Fewer complications than surgery Much shorter recovery time with rapid return to normal activities. No surgical incision. Radiofrequency ablation minimizes the risk of permanent damage to the vocal cord nerve or to the parathyroid glands. Radiofrequency ablation does not cause any scarring to the external neck. In most cases, one puncture of the skin is sufficient to treat the entire thyroid gland Because it is minimally invasive and does not require general anesthesia, you avoid the internal and external scarring of traditional thyroid surgery, and the associated risks of anesthesia. Pre-procedural symptoms with difficulty swallowing, feelings of pressure or tightness of the throat, or even the bulky appearance of the nodule are significantly decreased or no longer detectable. The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain. Other than the initial injection of numbing medication, the only remaining sensation is generally pressure and of increased heat in the neck area. Intermittent episodes of discomfort can be treated with additional doses of pain medication or adjustment of the probe tip. The procedure itself takes less than an hour, the entire process may take 2-3 hours. You should be able to return to most of your regular daily activities almost immediately. Radiofrequency thyroid ablation will not affect your energy or strength.

Symptoms of difficulty and discomfort with swallowing are commonly referred to as dysphagia. Swallowing is a very dynamic process which requires coordinated movement of the larynx, esophagus, and trachea. The thyroid is attached anteriorly to the trachea and larynx and can interfere with normal swallowing process when enlarged. Surgery to remove an enlarged thyroid gland can resolve symptoms of dysphagia. Surgery can also cause symptoms of dysphagia which did not exist before the operation. Post operative dysphagia is felt to be related to scarring, fibrosis, and nerve disruption associated with the removal of a thyroid gland. Often these symptoms may take months to resolve. With dysphagia associated with an enlarged thyroid nodule, the symptoms are related to the mass effect of the thyroid itself. Symptoms of dysphagia often take several months to resolve after surgery. In our recent clinical experience, patients who undergo radiofrequency ablation of the thyroid have rapid decrease in the nodule volume. As volume reduces symptoms from this enlargement resolve in a very short period as compared to surgery. This needs to be quantified in a scientific fashion. At the Thyroid Nodule Treatment Center, we will be studying the effects of RFA on all patients regarding their swallowing symptoms. We will have all patients complete surveys of their symptoms before and after their procedure, and in subsequent visits. This will help validate and measure the long lasting effects of RFA with symptoms that alter quality of life. Thank you in advance for your participation in this valuable study.

A traditional surgical treatment plan roadmap The management of enlarging visible or symptomatic thyroid nodules commonly requires surgery to remove this vexing, but not life-threatening problem. In all patients undergoing surgery, there are considerable fees for hospital resources and the numerous team members required for surgery and post- surgical recovery. The patients are followed for management of their new post-operative condition including medications and blood testing for many years and often for their entire life. The primary care provider initiates a thyroid evaluation with laboratory tests, and a neck ultrasound study. When a significant thyroid nodule is identified, then an ultrasound guided fine needle aspiration (FNA) of the nodule is obtained. FNA testing obtains thyroid cells for cytologic evaluation. When the cytologic evaluation of the nodule FNA is inconclusive, the biopsy can be repeated with genetic testing to help us determine that the lesion has low malignant potential. Inconclusive cytology and genetic results will often lead to the recommendation for thyroid lobe removal for pathologic evaluation. Surgical consultation is requested in these patients, and also for patients with large benign symptomatic nodules. The costs of a surgical approach The surgical removal of half or the entire thyroid gland requires a team of trained healthcare providers for successful implementation. The surgeon has his pre- and post-operative team in his office. The hospital has its pre and post-operative team, and provides the operating room with well trained nurses and operating technicians. Expensive operating equipment such as intraoperative nerve monitoring, as well as anesthesia equipment are utilized. During the post anesthesia period there is expensive monitoring equipment and well-trained hospital staff to ensure the safety of their patient. After surgery the patient is evaluated for thyroid gland function with blood testing. Hopefully, if the remaining thyroid is functioning properly, no medication will be necessary. If medications are required, the cost is likely over $100 per month . The monitoring of thyroid function is performed with blood testing of the serum TSH and Free T4 levels at least 4 times during the first year. These tests have a recurring expense of $90 – $280 each time. With all these essential resources necessary for patient safety, the overall charges for surgery range between 55,000 and 65,000 dollars ! The hospital generally charges between 35,000-50,000 dollars for this operation! The surgeon charges between $2500 to $5000. There is an anesthesia fee of about $2500. The removed tissue is sent for pathologic analysis which could cost from $450 to $1200. Total charges for typical thyroid surgery range between $55,000 to $65,000. The charge for Thyroid RFA ranges between $5,000 and $15,000 depending upon where it is performed. This is approximately 10% of the total charges associated with surgery. RFA Is an alternative to surgery that saves costs for the patient and medical system resources During the current pandemic and post-pandemic conditions, scheduling elective surgery is often difficult or impossible. The Thyroid RFA procedure provides an alternative to engaging overburdened hospital staff and facilities. Today, an option to avoid surgery is available when the thyroid nodule can be reliably proven to be benign. Thyroid ultrasound evaluation and cytologic evaluation are used to characterize the thyroid nodules. If favorable results are identified, we can safely determine that the nodules pose no significant harm for malignant potential. Instead of removal of the nodular thyroid gland, the individual nodules can now be destroyed inside gland without surgery.

Everyday new thyroid nodules are discovered by their physicians, family, friends, and even their hairdressers! Some people have symptoms related to the size of the nodules, which directs them to seek medical consultation. Others have no symptoms but learn about these nodules after undergoing radiologic testing for different reasons. The majority of thyroid nodules are benign. The most readily available modality for evaluating these is the ultrasound. The test is easily performed and avoids radiation exposure. The physician performed exam is much better than reviewing the still images saved on prior examinations. The study is easily repeated with no potential harm to the patient. With thyroid ultrasound there are several features in benign nodules that we like to identify to consider a lesion low risk of malignancy. When some of these features are absent, the nodule would be considered indeterminate, or potentially at risk for malignancy. These nodules will be tested using a biopsy to help the physician guide therapy. Not all nodules have the favorable ultrasound characteristics, and yet they may prove benign on biopsy. Additionally, a small percentage of nodules can have favorable findings on ultrasound and yet can be found to have papillary thyroid cancer. It is for these reasons that routine surveillance ultrasound is initiated once a nodule grows to about 15 mm in largest dimension.

The proper evaluation of these nodules is very routine. Much of the thyroid assessment is based on the size of the nodule. Once nodules measure about 15 mm, size criteria are met for recommending an ultrasound guided biopsy. If there are some concerning features seen on ultrasound in a smaller nodule, a biopsy can be performed even if the size criteria are not met. Additionally, a nodule which is enlarging over a short time period should be sampled under ultrasound guidance. Very small nodules under 6 mm do not require a biopsy under most conditions. Many patients inquire if the presence of a nodule alters thyroid function. Generally, nodules do not alter normal thyroid function. Routine blood testing are performed to assess thyroid function. Hypothyroidism is not caused by thyroid nodules. If a patient has hypothyroidism, they should be thoroughly evaluated by their primary physician or an endocrinologist. Hyperthyroidism is rarely caused by toxic thyroid nodules. These nodules hyper-function and drive the hormone levels to an abnormal range. These over-functioning nodules cause symptoms of fatigue, insomnia, increased heart rate, and heat intolerance. If these symptoms exists an endocrinologist is needed to regulate and suppress the thyroid function to normal levels. Further interventions can then be considered to restore normal thyroid function.