A goiter is the abnormal enlargement of the thyroid gland and is a common disorder of the thyroid gland. The growth can be diffuse (one lobe or whole gland) or nodular (gland forms nodules, lumps, or masses).

The presence of a goiter does not necessarily mean that the thyroid gland is malfunctioning. A goiter can occur in a thyroid gland that is producing too much thyroid hormone (hyperthyroidism), too little thyroid hormone (hypothyroidism), or the correct amount of thyroid hormone (euthyroidism).

 

Enlarged thyroid symptoms associated with goiter patient

How would you know you need a goiter treatment?

If you have a goiter, you may feel swelling in your neck, a tight feeling in your throat, coughing, difficulty swallowing, difficulty breathing, hoarseness, and feeling as though food is getting stuck in your throat. These can all be signs and symptoms of a goiter; however, you may experience other signs and symptoms depending on the underlying cause of the goiter.   

Tests for goiter treatment include: 

  • Blood work to check thyroid levels 
  • Ultrasound of thyroid 
  • Fine needle aspiration: Usually required to determine the underlying cause of the goiter and to exclude cancer  
  • Thyroid  uptake scan: This can be necessary for certain patients  

What are the types of goiter disease (enlarged thyroid)?

The type of presented goiter disease depends on the goiter cause. Types of goiter diseases include: 

Simple /Nodular goiter: 

  • This is caused by an inadequate supply of thyroid hormone needed to sufficiently supply the body.  
  • The thyroid gland tries to make up for this inadequacy by enlarging.   

 Colloid goiter:  

  • This occurs in people within a certain geographic area who do not get enough iodine (iodine is necessary to make thyroid hormone) in their diet.

Sporadic goiter:  

  • Non-toxic.
  • No known cause.

Toxic or Graves’ disease 

  • A disease in which your body’s immune system mistakenly attacks your own body.  
  • In this case, the thyroid gland is attacked, causing it to produce too much thyroid hormone, resulting in nodules of the gland.   

Hashimoto’s disease: 

  • A disease caused by auto-inflammation of the thyroid gland, which results in the underproduction of thyroid hormones.
  • Numerous patients develop diffuse nodules replacing their normal glands.  

What are the complications of Goiter disease?

If your goiter continues to grow, it can compress vital structures on your necks, such as your airway and food pipe. You will experience progressive difficulty in swallowing, difficulty breathing, and/or the sensation of a foreign body in your neck.  You may also experience hoarseness of voice.

Your goiter can also go through changes such as sudden internal bleeding or infarction. In these cases, you may experience acute neck pain and fullness, which may continue for days.

What are your options for treatment of goiter disease ?

Your options for nodular goiter treatment depend on the size of the enlargement, your symptoms, and the underlying cause.   

If you have a non-bothersome, small Goiter/nodule (non-toxic), your doctor may decide that you do not need treatment at this time. However, you will still need to continue monitoring your goiter for changes. 

If your goiter is large (toxic), disfiguring, or symptomatic, you will need to seek treatment options for your goiter which includes: 

  •  Surgery: The removal of one half or the entirety of your thyroid gland.  
  •  Radio Frequency Ablation (RFA): Non-surgical option in which the nodule is only ablated/ targeted, allowing you to keep your thyroid gland intact.

What are the drawbacks of treating goiter disease with surgery?

Surgery entails removing half of or the entire thyroid gland. Therefore, you will lose at least part of the thyroid gland with a surgical procedure.

Due to this, following a thyroidectomy, the majority of patients will need thyroid hormone replacement medication for the rest of their lives. There is a longer recovery time following surgery as compared to a non-surgical option. Furthermore, you may have a postoperative scar on your neck.

There is also is a risk of accidental injury to your vocal cords, nerves, and/or the accidental removal of the parathyroid glands (calcium regulator glands) in addition to the risks posed by undergoing a procedure under general anesthesia.  

Can anyone get nodular goiter treatment without surgery?

The answer to this question is yes. Anyone can receive nodular goiter treatment without undergoing surgery. If you decline surgery, prefer a non-surgical intervention, or are not a good surgical candidate (high risk), you can receive non-surgical treatment such as RFA.  

You can benefit from RFA if you have a goiter which is: 

  • Large and growing rapidly.
  • Causing cosmetic problems.
  • Causing neck compression symptoms.
  • Causing anxiety due to its presence.

Benefits to choosing radiofrequency ablation for goiter treatment over surgery?

  • Thyroid Radiofrequency Ablation (RFA) is a very safe procedure with minimal risk. The entire RFA procedure is done through a small needle puncture into your neck. There is no postoperative scar or need for sutures to be placed.  
  • It is performed under local anesthesia, so you can avoid all complications related to general anesthesia. 
  • No down time: You can resume your normal activities the day after your RFA procedure.
  • Unlike surgery, no thyroid hormone replacement medications are needed following an RFA procedure. 

Learn more about enlarged thyroid treatment without surgery by performing Radiofrequency ablation treatment 

About the possible side effects of using radiofrequency ablation for goiter treatment

As with any medical procedure there is some inherent risk associated with an RFA procedure. However, RFA has a very low complication rate and minor side effects as compared to surgery.

Some risks and rarely-reported side effects include: 

  • Temporary hoarseness 
  • Minor skin bruising 
  • Burn at needle entry site 
  • Minimal bleeding 
  • Nodule rupture 
  • Skin infection  
  • Thyrotoxicosis 
  • Hypothyroidism 
  • Fever 
  • Wound infection

How long does it take to recover from RF ablation treatment of goiter disease?

The RFA procedure is approximately 30-45 minutes long, depending on your nodule size. It is done at our center as an office-based procedure under local anesthesia. You can go to work and resume your normal activity the next day. 

About our approach to goiter treatment

The Thyroid RFA procedure is very tolerable, and it is done with local neck anesthesia at our center. 

Prior to your RFA you will have a consultation visit with Dr. Elshenawy. She will perform an in-office ultrasound scan of your nodule and review your fine needle biopsy results. Upon her evaluation, she will determine if another FNA prior to RFA is required.  

She will explain in detail the RFA procedure, benefits, risks, possible outcomes, and alternative options. A limited blood work panel for thyroid function and blood coagulation factors before the RFA procedure will be required. You will have opportunities to ask questions and address your concerns. 

 

The day of RFA  

In-Office Preoperative Preparation: 

  • You will come to our center to fill out all necessary paperwork. 
  • You will change your clothes into the provided disposable gown. No jewelry, body piercings, or metalware can be worn during the procedure. 
  • The patient is able to breathe and talk during the entirety of the RFA. You will be able to converse with the doctor during the procedure. 
  • Two grounding pads will be attached to the front of your thighs. 
  • Your neck will be cleaned with skin antiseptic. Then, under sterile conditions, marks will be placed on your skin to demarcate parts of the nodule. The patient’s head will rest on a small cushion and their eyes will be covered with a mask. 
  • Your heart rate, blood pressure and voice are monitored during the entire RFA. 

RFA Procedure: 

  • First, your doctor will place a local anesthetic under the skin in the front of the neck and surrounding the thyroid gland. 
  • Second, using the same entry hole on the neck, a thin probe will pass into your neck, targeting your thyroid nodule. The RFA will start by ablating the deeper and posterior portion of your nodule. It will then proceed to superficial and anterior portions of your nodule. 
  • A “popping” sound will be heard during the RFA as the tissue is sequentially and successfully being ablated.

In-Office Postoperative Procedure: 

  • After your ablation, an ice pack will be placed on your neck. You will be monitored for approximately 30 minutes and will then be discharged. 
  • You will be given over the counter medication such as acetaminophen (Tylenol) for inflammation after RFA. 

The day after the RFA, your neck will be mildly sore but you will be able to resume all your normal activities. You will be advised to refrain from extra-strenuous activities for 48 hours if possible. 

Follow-up care after RFA will require periodic ultrasound scans to monitor your nodule size. Additionally, some thyroid blood work will be repeated.

Why OCC thyroid center for your goiter’s condition treatment?

The OCC thyroid center is accredited by the College of American Pathologists (CAP). Our Center is the first Interventional Cytopathologist in the USA to Perform Thyroid RFA.

  • Our providers are USA board-certified MD & ECNU certified.
  • Our three doctors have collectively performed more than 50,000 thyroid/parathyroid interventional procedures including FNA biopsies, ethanol ablation, and RFA procedures.  
  • RFA technique at our center is safe and FDA approved.   
  • Our center has been established since 1991, and is considered a national leader in thyroid disease diagnosis.  
  • We provide non surgical toxic and non toxic nodular goiter treatment. RFA treatment is performed by our experienced physicians. 
  • We only ablate and target your goitrous nodule , preserving the remainder of your gland.  
  •  Our center has a patient centered approach to medical care and devotion to all of  our patients, as we understand each patient’s condition and circumstance is unique.  
  • RFA  procedures at our OCC center are more cost effective than hospital-based procedures, as we charge no facility fees.

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