Thyroid nodule MWA ablation.Non-surgical treatment of thyroid nodules-goitre

What is a thyroid nodule, and what causes it?

A thyroid nodule is a small lump or growth that develops in the thyroid gland, which is located in the neck and produces hormones that regulate metabolism. Thyroid nodules are quite common, affecting up to 50% of the population in some studies. The causes of thyroid nodules are not always clear, but some risk factors have been identified, including age, female gender, exposure to radiation, iodine deficiency, and family history of thyroid disease. Most thyroid nodules are non-cancerous (benign), but some can be cancerous (malignant).

What are the symptoms of a thyroid nodule, and how is it diagnosed?

Many thyroid nodules do not cause any symptoms and are only discovered incidentally during a physical exam or imaging test. However, larger nodules or those that produce excess thyroid hormones can cause symptoms such as:

Swelling or lump in the neck

Difficulty swallowing or breathing

Hoarseness or voice changes

Rapid or irregular heartbeat

Fatigue or weakness

To diagnose a thyroid nodule, your doctor may perform a physical exam, order blood tests to check your thyroid hormone levels, and/or imaging tests such as an ultrasound, CT scan, or MRI. If the nodule appears suspicious, a fine needle aspiration biopsy may be performed to obtain a tissue sample for analysis.

What is a goitre, and how is it related to thyroid nodules?

A goitre is an enlargement of the thyroid gland that results in a visible swelling in the neck. Goitres can be caused by a variety of factors, including iodine deficiency, thyroid hormone imbalances, autoimmune disorders, and thyroid nodules. Thyroid nodules are a common cause of goitres, as they can cause the thyroid gland to grow in size as it tries to compensate for the increased activity or production of hormones. In some cases, goitres can also be a sign of thyroid cancer, so it is important to have them evaluated by a doctor.

Can thyroid nodules or goitres be prevented?

There is no surefire way to prevent thyroid nodules or goitres, but maintaining a healthy diet with adequate iodine intake may help reduce the risk of goitre formation. Avoiding exposure to radiation, especially in childhood, may also reduce the risk of developing thyroid nodules.

Are thyroid nodules or goitres typically cancerous?

Most thyroid nodules are benign and not cancerous, but about 5-10% of nodules turn out to be malignant. The risk of malignancy is higher in certain populations, such as those with a history of radiation exposure or a family history of thyroid cancer.

Similarly, most goitres are not cancerous, but in some cases, a large or rapidly growing goitre may be a sign of thyroid cancer. Therefore, it is important to have any nodules or goitres evaluated by a healthcare professional, who can determine if further testing or treatment is necessary.

What is the prognosis for thyroid nodules or goitres?

The prognosis for thyroid nodules or goitres depends on several factors, including whether the growth is cancerous or benign, the size and location of the growth, and the age and overall health of the patient. Most benign nodules or goitres can be successfully treated with medication or surgery, and have a good prognosis. However, if left untreated or undiagnosed, thyroid cancer can be more difficult to treat and may have a poorer prognosis.In summary, thyroid nodules and goitres are common conditions that affect the thyroid gland. While most nodules and goitres are benign, it is important to have them evaluated by a healthcare professional to determine if further testing or treatment is necessary. With proper diagnosis and treatment, most patients can expect a good prognosis.

Can thyroid nodules or goitres cause weight gain?

Thyroid nodules or goitres themselves are not known to cause weight gain. However, if a nodule or goitre is producing excess thyroid hormones (a condition known as hyperthyroidism), it can cause weight loss or difficulty gaining weight. Conversely, an underactive thyroid gland (hypothyroidism), which can also be caused by thyroid nodules or goitres, can cause weight gain.

Can thyroid nodules or goitres affect fertility?

Thyroid nodules or goitres themselves are not typically known to directly affect fertility. However, thyroid function can have an impact on reproductive health, and thyroid disorders have been associated with infertility, miscarriage, and other reproductive problems. Therefore, it is important for anyone experiencing fertility issues to have their thyroid function evaluated by a healthcare professional.

Can thyroid nodules or goitres be treated with alternative or natural therapies?

There is limited evidence to support the use of alternative or natural therapies for thyroid nodules or goitres. Some people may find that certain lifestyle changes, such as reducing stress or improving nutrition, can help manage thyroid health. However, any complementary therapies should be discussed with a healthcare professional before starting, as some natural supplements can interact with thyroid medications and cause unwanted side effects.

Can thyroid nodules or goitres cause throat pain?

Thyroid nodules or goitres can cause throat pain, especially if they are large or located near the windpipe or esophagus. The pain may be described as a feeling of pressure or fullness in the throat, or as difficulty swallowing or breathing. If you are experiencing throat pain or other symptoms related to your thyroid, it is important to have them evaluated by a healthcare professional.

Can thyroid nodules or goitres be a sign of thyroid disease in children?

Thyroid nodules and goitres are less common in children than in adults, but they can still occur. Children with thyroid nodules or goitres may experience symptoms such as difficulty swallowing or breathing, hoarseness, or a visible swelling in the neck. If your child is experiencing any of these symptoms, it is important to have them evaluated by a pediatrician or endocrinologist, who can determine the underlying cause and recommend appropriate treatment.

Can thyroid nodules or goitres cause anxiety or other emotional symptoms?

Thyroid nodules or goitres themselves are not typically known to cause anxiety or other emotional symptoms. However, thyroid disorders such as hyperthyroidism or hypothyroidism can affect mood and emotional wellbeing. If you are experiencing anxiety or other emotional symptoms in conjunction with thyroid-related symptoms, it is important to discuss these concerns with a healthcare professional.

Can thyroid nodules or goitres be a sign of thyroiditis?

Thyroid nodules and goitres can be a sign of thyroiditis, which is inflammation of the thyroid gland. Thyroiditis can have various causes, such as infection, autoimmune disease, or exposure to radiation. Depending on the underlying cause, thyroiditis may require different treatments than other types of nodules or goitres.

Can thyroid nodules or goitres cause voice changes?

Thyroid nodules or goitres that are located near the vocal cords can cause voice changes, such as hoarseness or difficulty speaking. This occurs because the growth can interfere with the normal functioning of the vocal cords. If you are experiencing voice changes or other symptoms related to your thyroid, it is important to have them evaluated by a healthcare professional.

What is a thyroid biopsy?

A thyroid biopsy, also known as a fine-needle aspiration (FNA) biopsy, is a procedure used to collect a small sample of tissue from the thyroid gland for examination under a microscope. The biopsy is typically performed with a thin needle and is done under local anesthesia.

Why is a thyroid biopsy done?

A thyroid biopsy is typically done to determine if a thyroid nodule or goitre is cancerous or benign. A biopsy can also help determine the underlying cause of a nodule or goitre, such as autoimmune disease or infection.

Is a thyroid biopsy painful?

A thyroid biopsy is typically done under local anesthesia, which can cause some discomfort or pressure. However, most patients report only mild discomfort during the procedure. After the procedure, some patients may experience mild pain or soreness in the biopsy site, which can be managed with over-the-counter pain medication.

How accurate is a thyroid biopsy?

According to a meta-analysis of studies published in the journal Thyroid, the overall diagnostic accuracy of thyroid biopsy for detecting thyroid cancer is approximately 82%. The accuracy of the biopsy can depend on several factors, such as the size and location of the nodule, the experience of the healthcare professional performing the biopsy, and the interpretation of the biopsy sample.

What are the risks of a thyroid biopsy?

The risks of a thyroid biopsy are generally minimal, but can include bleeding, infection, and damage to nearby structures. According to a review article in the journal Thyroid, serious complications from thyroid biopsy are rare, occurring in less than 1% of cases.

How long does it take to get results from a thyroid biopsy?

The time it takes to get results from a thyroid biopsy can vary, but typically ranges from a few days to a week. The results of the biopsy will be reviewed by a pathologist, who will provide a diagnosis based on the microscopic examination of the tissue sample.

What happens if a thyroid biopsy shows cancer?

If a thyroid biopsy shows cancer, further testing and treatment will be recommended. Treatment options for thyroid cancer can include surgery, radiation therapy, and chemotherapy, depending on the type and stage of the cancer.

Can a thyroid biopsy be repeated?

If a thyroid biopsy does not provide a clear diagnosis or if a nodule or goitre continues to grow or change over time, a repeat biopsy may be recommended. According to a review article in the journal Thyroid, repeat biopsies have a diagnostic accuracy of approximately 85%.

How can I prepare for a thyroid biopsy?

Before a thyroid biopsy, you should inform your healthcare professional of any medications you are taking and any medical conditions you have. You may be asked to stop taking blood thinners or other medications that can increase the risk of bleeding during the procedure. You should also arrange for someone to drive you home after the procedure, as you may experience some mild discomfort or dizziness afterwards.

Is there anything I should do after a thyroid biopsy?

After a thyroid biopsy, you should avoid strenuous activity and heavy lifting for a few days to reduce the risk of bleeding or bruising. You may also experience some mild pain or soreness at the biopsy site, which can be managed with over-the-counter pain medication. If you experience any signs of infection, such as redness, swelling, or fever, you should contact your healthcare professional.

Are there any alternatives to a thyroid biopsy?

There are several non-invasive imaging tests, such as ultrasound and computed tomography (CT), that can be used to evaluate thyroid nodules and goitres. However, these tests cannot definitively diagnose cancer or determine the underlying cause of a nodule or goitre. A biopsy is typically recommended for patients with suspicious nodules or goitres.

How often should I get a thyroid biopsy?

The frequency of thyroid biopsies depends on several factors, such as the size and characteristics of the nodules or goitres, the patient's age and medical history, and the presence of any risk factors for thyroid cancer. Your healthcare professional will recommend a schedule for follow-up testing and monitoring based on these factors.

Do all benign thyroid nodules require treatment?

Not all benign thyroid nodules require treatment. In many cases, small nodules that do not cause any symptoms or growth are simply monitored over time to ensure that they do not become larger or cause any problems. However, larger nodules or those causing symptoms such as difficulty swallowing, shortness of breath, or vocal changes may require treatment.

What are the treatment options for benign thyroid nodules?

The treatment options for benign thyroid nodules depend on several factors, including the size and characteristics of the nodule, the presence of symptoms, and the patient's medical history and preferences. The following are the most common treatment options for benign thyroid nodules:

Observation: In many cases, small nodules that do not cause any symptoms or growth are simply monitored over time to ensure that they do not become larger or cause any problems. The American Thyroid Association recommends follow-up every 6-18 months with ultrasound for nodules smaller than 1 cm in size.

Medication: Levothyroxine is a medication used to suppress the thyroid gland and shrink nodules. Studies have shown that levothyroxine treatment for benign thyroid nodules can reduce nodule volume by 24% to 50%, depending on the dose and duration of treatment. However, the effect of levothyroxine on nodule symptoms is less clear. Patients who are considering medication should discuss the benefits and risks with their healthcare professional.

Radiofrequency ablation (RFA): RFA is a minimally invasive procedure that uses heat to destroy thyroid nodules. Studies have shown that RFA is effective in reducing the size of nodules and improving symptoms, with a low rate of complications. A meta-analysis of 17 studies with 1,677 nodules found a mean volume reduction rate of 66.8% at 12 months and 80.6% at 24 months.

Surgery: Surgery, known as a thyroidectomy, may be recommended for large nodules causing symptoms or those that are growing rapidly. The surgical removal of benign thyroid nodules is generally safe but carries some risks, such as bleeding, infection, and damage to the laryngeal nerves or parathyroid glands. The rate of complications varies depending on the extent of the surgery and the experience of the surgeon.

Ethanol ablation (EA): Ethanol ablation involves injecting ethanol into the thyroid nodule to destroy it. A meta-analysis of 24 studies with 1,357 nodules found that ethanol ablation was effective in reducing the size of nodules by 80.4% at 12 months, and the complication rate was 2.2%. However, EA is not as commonly used as RFA and requires more expertise in performing the procedure.

Radioiodine treatment

Observation with risk stratification: The use of ultrasound-based risk stratification models, such as the Thyroid Imaging Reporting and Data System (TI-RADS), can help determine the risk of malignancy and guide the frequency of follow-up ultrasound scans. Low-risk nodules can be safely monitored over time with periodic ultrasound scans, while high-risk nodules may require further evaluation and treatment.

Overall, the choice of treatment for benign thyroid nodules should be individualized based on the size and characteristics of the nodule, the presence of symptoms, and the patient's medical history and preferences. Patients should discuss the risks and benefits of each treatment option with their healthcare professional to determine the best course of action.

Is medication a safe and effective treatment for benign thyroid nodules?

Medication, such as levothyroxine, can be effective in reducing the size of benign thyroid nodules. However, it is not always effective and may not be suitable for all patients. Additionally, medication may have side effects such as heart palpitations, increased appetite, and weight loss. Patients who are considering medication should discuss the benefits and risks with their healthcare professional.

Are there any risks associated with surgery to remove benign thyroid nodules?

Surgery to remove benign thyroid nodules is generally safe but like any surgical procedure, it does carry some risks, such as bleeding, infection, damage to the laryngeal nerves or parathyroid glands, and hoarseness. Patients should discuss the risks and benefits of surgery with their healthcare professional.

Can benign thyroid nodules recur after surgery?

Benign thyroid nodules can recur after surgery. The risk of recurrence depends on several factors, including the type of treatment, the size and characteristics of the original nodule, and the patient's age and medical history. Patients should continue to undergo periodic follow-up testing to monitor for any recurrence or new nodules.

Can lifestyle changes help in the treatment of benign thyroid nodules?

While lifestyle changes may not directly treat benign thyroid nodules, they can help improve overall thyroid health and potentially prevent the growth of new nodules. Some lifestyle changes that may be helpful include maintaining a healthy diet, getting regular exercise, and avoiding smoking and excessive alcohol consumption. Patients should also ensure that they are getting enough iodine, a mineral that is essential for thyroid function. However, patients should speak to their healthcare professional before making any significant lifestyle changes.

How often should I have follow-up testing after treatment for benign thyroid nodules?

The frequency of follow-up testing after treatment for benign thyroid nodules varies depending on the individual patient and the type of treatment. Patients who undergo observation may require periodic ultrasound scans to monitor for any growth or changes in the nodules. Patients who receive medication or RFA may require periodic testing to monitor the effectiveness of the treatment. Patients who undergo surgery to remove nodules may require follow-up testing to ensure that the nodules do not recur. Patients should discuss their follow-up plan with their healthcare professional.

What is Radiofrequency Ablation (RF) F or Microwave Ablation (MWA) for benign thyroid nodules?

RF and MWA ablation are minimally invasive procedures that use heat energy to destroy benign thyroid nodules. During the procedure, a thin needle is inserted into the nodule, and heat energy is delivered to the nodule, causing it to shrink and eventually be absorbed by the body.

How effective is RF or MWA ablation for benign thyroid nodules?

Studies have shown that both RF and MWA ablation are effective in reducing the size of benign thyroid nodules and improving symptoms, with a low rate of complications. A meta-analysis of 33 studies with 2,625 nodules found that the mean volume reduction rate after RF ablation was 61.5% at 12 months and 70.9% at 24 months. Another meta-analysis of 14 studies with 798 nodules found that the mean volume reduction rate after MWA ablation was 69.6% at 6 months and 81.2% at 12 months. Both procedures have also been shown to be effective in improving symptoms such as pressure, pain, and hoarseness.

How safe is RF or MWA ablation for benign thyroid nodules?

Both RF and MWA ablation are considered safe procedures with a low risk of complications. The most common complications are temporary pain or discomfort at the site of the procedure, voice changes, and transient hypothyroidism. Serious complications such as bleeding, infection, and nerve damage are rare, occurring in less than 1% of cases. The risk of complications may be higher in patients with large nodules, those with nodules close to vital structures, and those with a history of thyroid surgery or radiation.

What is the recovery time after RF or MWA ablation?

The recovery time after RF or MWA ablation is generally quick, with most patients able to resume their normal activities within a few days. Patients may experience mild pain or discomfort at the site of the procedure for a few days, but this can usually be managed with over-the-counter pain relievers. Voice changes and transient hypothyroidism may occur, but these typically resolve within a few weeks.

What is the follow-up protocol after RF or MWA ablation?

The follow-up protocol after RF or MWA ablation varies depending on the individual patient and the size and characteristics of the nodule. Most patients require periodic ultrasound scans to monitor the effectiveness of the procedure and to detect any recurrence of the nodule. Patients should discuss their follow-up plan with their healthcare professional.

How does RF or MWA ablation compare to surgery for benign thyroid nodules?

RF and MWA ablation are minimally invasive procedures that are generally considered safe and effective alternatives to surgery for the treatment of benign thyroid nodules. Compared to surgery, RF and MWA ablation have several advantages, including a shorter recovery time, lower risk of complications, and no need for general anesthesia.

Can RF or MWA ablation be used for multiple nodules?

RF and MWA ablation can be used to treat multiple nodules, but the decision to do so depends on the size and location of the nodules and the individual patient's health status. Multiple nodules may require multiple ablation sessions.

How long does the effect of RF or MWA ablation last?

The long-term effectiveness of RF or MWA ablation for benign thyroid nodules is still being studied, but current evidence suggests that the effects are generally long-lasting. A study of 150 patients with benign thyroid nodules who underwent RF ablation found that 94% had a sustained reduction in nodule volume at a median follow-up of 42 months. Another study of 96 patients with benign thyroid nodules who underwent MWA ablation found that 89.6% had a sustained reduction in nodule volume at a median follow-up of 18 months.

Is RF or MWA ablation painful?

RF and MWA ablation are typically performed under local anesthesia, which numbs the area around the nodule being treated, so patients generally do not experience pain during the procedure. However, patients may experience some discomfort, such as a sensation of pressure or warmth, during the ablation. After the procedure, patients may experience some soreness or discomfort in the neck area, but this can usually be managed with over-the-counter pain relievers.

What are the potential risks or side effects of RF or MWA ablation?

The risks and side effects of RF and MWA ablation are generally low, but they can include temporary hoarseness, sore throat, skin burns, bleeding, and infection. More serious complications, such as damage to the recurrent laryngeal nerve, are rare but can occur. Patients should discuss the potential risks and benefits of the procedure with their healthcare provider before undergoing RF or MWA ablation.

How long does the RF or MWA ablation procedure take?

The duration of the RF or MWA ablation procedure depends on the size and location of the nodule being treated. Generally, the procedure takes between 30 minutes and 2 hours to complete.

What are benefits of RFA and MWA compared to other treatments?

Radiofrequency ablation (RFA) and microwave ablation (MWA) are minimally invasive procedures that have been shown to be effective in reducing the size of benign thyroid nodules. Compared to other treatment options, RFA and MWA have several potential benefits:

Non-surgical: RFA and MWA are minimally invasive procedures that do not require surgery, which means that they can be performed on an outpatient basis and do not involve the risks and potential complications associated with surgery.

Fast recovery time: Patients undergoing RFA or MWA can generally resume normal activities within a few days of the procedure, which means that there is minimal disruption to their daily lives.

Fewer side effects: RFA and MWA are associated with fewer side effects than surgery, which can involve risks such as bleeding, infection, and damage to the parathyroid glands or the recurrent laryngeal nerve.

Cost-effective: RFA and MWA may be less expensive than surgery, particularly for patients who require multiple treatments.

Compared to other non-surgical treatments, such as observation or thyroid hormone therapy, RFA and MWA have been shown to be more effective in reducing the size of thyroid nodules. For example, a study published in the Journal of Vascular and Interventional Radiology found that RFA was more effective than observation in reducing the volume of thyroid nodules, with a success rate of 86% compared to 3% for observation.

In conclusion, while RFA and MWA are relatively new treatments for benign thyroid nodules, they have been shown to be effective and have several potential benefits compared to other treatment options. Patients should discuss their individual circumstances with their healthcare provider to determine the most appropriate treatment option for them.

Who is a good candidate for RF or MWA ablation?

RF and MWA ablation are generally recommended for patients with benign thyroid nodules that are above 2 cm and  causing symptoms, such as difficulty swallowing or breathing, or that are growing in size. RF or MWA ablation of benign thyroid nodules may be indicated for patients who have nodules that are causing symptoms or cosmetic concerns, or that are growing in size. Indications for RF or MWA ablation may include:

Thyroid nodules causing compressive symptoms, such as difficulty swallowing or breathing.

Thyroid nodules causing cosmetic concerns, such as a visible lump on the neck.

Thyroid nodules that are growing in size despite conservative management.

Patients who are not candidates for surgery due to medical comorbidities or other factors.

Patients who prefer a minimally invasive approach to treatment.

Before recommending RF or MWA ablation, healthcare providers will typically perform a thorough evaluation to determine the size and location of the thyroid nodule, as well as the patient's overall health status and any contraindications to the procedure. Patients should discuss their individual circumstances with their healthcare provider to determine if RF or MWA ablation is a suitable treatment option for them.

What happens during RFA and MWA procedures?

You will be prepared for the procedure and you will be laid on the table in a sterile manner. We do not give general anesthesia in the procedures because the risks and complications of stunning with general anesthesia are unnecessary and excessive for such a procedure. Some sedatives, pain relievers, edema solvents and antibiotics will be given intravenously. First, mapping and planning will be done with ultrasonographic evaluation. Then, local anesthetic substances will be given under the skin and around the thyroid membrane so that you do not have pain during the procedure. These local anesthetics will cause burning and mild pain in your body like fever, but this is very short in duration. Then, if your nodules are in the vicinity of critical vessels, nerves or vocal cords, sugar-filled water will be given to their neighbors to remove them from these areas, and a fluid-filled space will be created and removed from these critical structures. Thus, the risk of complications and damage will be reduced even if it is very low. When the burning process starts, you may feel like an electric shock hitting both your jaws and teeth. This is a normal operation condition. This condition can sometimes be seen under the shoulder blades, on the neck and around the face. It is a very short temporary situation. If you have pain during the burning process, you will warn your doctor and the parameters of the burning process will be rearranged, and the energy level will be reduced. During the burning process, patting air bubbles will form in your nodules and you will feel it. You will hear sounds similar to the popping sound of balloons on air bubble nylons. This is an indication that the operation was successful. Since the process takes place in very critical areas, you will be asked not to swallow, move or cough if possible. During the procedure, your doctor will talk to you and evaluate possible hoarseness. After the procedure is completed, an ice block will be placed on the neck area and the edema will be resolved. Hoarseness lasting 2 hours during and after the procedure can be observed in some patients. The reason for this is that there is water collection in the nodules due to burning, which we call edema, and there is already pressure due to edema in the nodules close to the vocal cords. Very rarely, this condition may last up to 3 months, and even more rarely (below one percent), it may be permanent. In such a case, necessary treatments will be arranged. Such risks and complications are much higher in surgical methods. During the first 24 hours and 1 week, you may have a tingling sensation, numbness, swelling, small purple-brown bleeding areas in your neck. Difficulty in swallowing, feeling of tension and pain while eating, cough, discomfort in the neck can be seen again in this period, and these will decrease and disappear. You will be discharged and sent home 4 hours after the procedure. You will be advised to use your medications correctly and properly and to come for follow-ups. After about 6 months, you will be asked to discontinue the thyroid-related drugs you used before under the endocrinology control.

Can thyroid rf-mwa ablation procedures be applied in hormone producing toxic nodules (toxic goiter)?

Yes, recent studies and guidelines have reported that this procedure can be successfully applied in hormone-producing nodules even if they are below 2 cm. This is especially recommended for younger patients. Because, after surgery or radioactive iodine (atom) treatment, permanent low thyroid hormone can be observed, which may require lifelong medication.

Does cancer develop from the burned place?

No. Cancer does not develop from the burned area because this place gets smaller and smaller.The hard tissue we call fibrotic tissue develops and it is not possible for the development of new vessels necessary for the development of cancer. However, the probability of developing cancer from the vicinity of the burned area or from another nodule or thyroid tissue is at the same rate as people who are not normal patients.

Could RFA and MWA be used for treatment of malignant thyroid nodules?

Yes. In single, below 2cm, papillary type malignant thyroid nodules RFA and MWA asre safe and effective.