The mission of TNTC is preservation of normal thyroid function while treating benign symptomatic thyroid nodules using the most advance minimally invasive treatments available.
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.
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.
3D animation video showing the principles of the moving shot technique when performing a Radio Frequency Ablation (RFA) of the Thyroid under ultrasound guidance.
Thyroid Nodule Radiofrequency Ablation Lecture With Richard Harding, MD, FACS
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.
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