Thyroid Nodules Treatment and Diagnosis l OCC clinic

Thyroid nodules are common and are present as either a clinically palpable mass or as an incidental finding on imaging studies. Thyroid nodules can be detected in more than 50% of the population; fortunately, approximately 95% are benign. Most people know them by the name “Goiter”. 

It is of paramount importance to triage patients preoperatively into one of two groups: Patients with nodules that can be conservatively managed and patients who need intervention. Intervention option may include non-surgical treatment of thyroid nodules by Radiofrequency Ablation (RFA) or surgical removal (thyroidectomy).

Symptoms caused by growing of thyroid nodules

How would you know you have or need a thyroid nodule treatment?

If your benign thyroid nodule continues to grow and/or cause swelling in your neck, a tight feeling in your throat, coughing, difficulty swallowing, difficulty breathing, hoarseness, and feeling like food gets stuck in your throat, it is important to understand that these all can be signs and symptoms that your nodule is compressing on nearby vital neck structures. You may experience other signs and symptoms depending on the underlying cause and location of your nodule.

Before undergoing any intervention or seeking any thyroid nodules treatment, the most important step is to have a fine needle aspiration (FNA) biopsy.  FNA is a pivotal tool for thyroid evaluation. Once your thyroid nodule is deemed benign, you can seek options to clear your symptoms.

What are the types of benign thyroid nodules?

The thyroid may contain just one nodule or several of them (multinodular goiter). 

Mainly, the benign thyroid nodules can be grouped into two categories, including:

Non-functioning thyroid nodule:

Non-functioning nodules can sometimes appear as “cold spots” on scans, which is indicative of non-functioning tissue in the thyroid gland.

A cold or non-functioning nodule carries higher cancer risk than a normal or hyper-functioning nodule.

In most cases there are two groups of non-functioning thyroid nodules: 

Cystic / complex thyroid nodules:

When nodules contain fluid, they are called cystic nodules. These can be completely fluid-filled (simple cysts) or partly solid and partly fluid-filled (complex cysts).

Cystic nodules are usually benign and cause no trouble.

If they become symptomatic and bothersome, your doctor will refer you for thyroid cyst treatment to prevent the growth and any complications.

Treatment of cystic thyroid nodules includes non-surgical options such as ethanol ablation/sclerotherapy or surgical removal.

Solid thyroid nodules:

Thyroid nodules can be solid if they are composed predominantly of thyroid follicular cells. When large enough and symptomatic, they can be treated with surgery or non-surgical radiofrequency ablation.

Hyperfunctioning thyroid nodule:

A hyperfunctioning thyroid nodule (hot nodule) is a nodular region of the thyroid gland which secretes excess thyroid hormone. It is visualized as a “hot spot” on thyroid scans. They can cause swelling in your neck and lead to breathing and swallowing difficulties, pain, and goiter.

Treatment of hyperfunctioning thyroid nodules includes non-surgical options such as radiofrequency ablation and radioactive iodine treatment, or surgical removal.

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If you have benign thyroid nodules, what are your options for managing thyroid nodules?

Usually, if your benign nodule is asymptomatic and not clinically endangering vital neck organs, the condition will be managed conservatively with repeated scans to monitor changes in your  thyroid nodule.

Conversely, if the benign nodule is causing persistent symptoms, there are three options you should consider:

Surgery: removing half or the entire thyroid gland 
RFA: Non-surgical radiofrequency ablation for thyroid nodule
Ethanol Ablation: Non-surgical  sclerotherapy for cystic nodules

The correct treatment plan for your condition depends on your nodule size, symptoms, general health conditions, and your doctor’s recommendations.

If you have any symptoms or feel that you are developing thyroid nodules or its associated symptoms, please consult with your primary care doctor. In some cases, your doctor may refer you to a specialist called an endocrinologist.

If you have any of these symptoms or feel that you are developing thyroid nodules or its associated symptoms, please consult with your primary care doctor. In some cases your doctor may refer you to a specialist called an endocrinologist.

What are the drawbacks of removing benign thyroid nodules with surgery?

Surgery entitles removing half or the whole thyroid gland. Therefore you will lose at least part of your thyroid gland. More than 50% of patients following thyroidectomy will need thyroid hormone replacement pills for life. 

There is a longer recovery time following surgery. You may have a  postoperative neck scar.In  addition to the risk of associated general anesthesia.

Also there is a risk of accidentally removing your parathyroid glands/tissue which might  lead to irregular calcium levels

Can anyone with benign nodules get thyroid nodules treatment without surgery?

You can benefit from RFA if you have a benign thyroid nodule which is:

Large and, or growing rapidly
Causing cosmetic neck problems
Causing neck compression symptoms
Causing anxiety due its presence
If you decline surgery or are not a good surgical candidate (high risk)

Benefits to choosing radiofrequency ablation for benign thyroid treatment over surgery

Radiofrequency Thyroid Ablation (RFA) is a safe procedure with minimal risk and complication. RFA procedure is similar to needle biopsy. A needle-like probe is inserted into the body to heat to shrink benign nodule.

This treatment option does not create a neck scar as suturing is not required.

Because this procedure is minimally invasive, the therapy may take place in an outpatient setting— typically takes 30-45 minutes depending on the nodule size.

Local anesthesia is used to help numb the skin of the neck and around the thyroid capsule . It also helps to relax the neck muscles . Since this is an outpatient procedure, you may resume your normal activity the day after treatment.

Since the thyroid gland is not removed, lifelong thyroid hormone replacement medications are not necessary

Learn more about the treatment of benign thyroid nodules without surgery by performing Radiofrequency ablation treatment

About the possible side effects of using radiofrequency ablation for benign thyroid nodules treatment

Temporary hoarseness
Minor skin bruise
Burn at needle entry site
Minimal bleeding
Nodule rupture
Thyrotoxicosis
Hypothyroidism
Fever
Infection at entry site

How long does it take to recover from radiofrequency ablation treatment of thyroid mass enlargement?

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

About our approach to thyroid nodules treatment?

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.

On your RFA procedure day:

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.

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 managing your benign thyroid nodules?

OCC thyroid center is dedicated to a patient-centered approach, with specialized and individualistic care. OCC thyroid center is accredited by the College of American Pathologists (CAP). Our providers are USA boarded, MD & ECNU certified providers with three doctors who have performed more than 50,000 thyroid interventional procedures including FNA biopsies, Ethanol Ablation, and RFA.

Our Center is the first Interventional Cytopathologist In the USA to Perform Thyroid RFA.
Our center has been established since 1991 and is considered a national leader in thyroid diagnosis.
We provide a nonsurgical alternative for cystic thyroid nodule treatment, hyperfunctioning thyroid nodule treatment, and other thyroid disorders that is performed by our experienced providers.
We only ablate and target your nodule in order to preserve the functions of your thyroid gland.
When considering financial cost, RFA procedures at our OCC center are more cost-effective than hospital-based procedures as we have no facility fee charge.

Benign Thyroid Treatment Without Surgery