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 than 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. 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.
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!
An alternative to surgery that saves costs for the patient and medical system resources
During the current pandemic, 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.
Large symptomatic thyroid nodules will shrink after RFA therapy and symptoms quickly resolve. The therapy, ”Thyroid RFA”. involves imparting radiofrequency energy within the thyroid nodules using specialized equipment. The treatment can be provided to patients in the specialized physician’s office under local anesthesia.
Because hospital facilities, general anesthesia, hospital equipment, and specialized staff requirements are avoided, the treatment is much less expensive. The risks of the procedure are considerably lower than a standard thyroid surgery because of the limited area treated within the thyroid gland. The thyroid gland continues to function so testing after the procedure is requires less often. The patient benefits with the retention of thyroid function and avoidance of future daily medication. They avoid the hospital time and expenses. There is no surgery, no scar, no anesthesia, or surgical recovery. With no surgical wound they return to work the following day after thyroid RFA with few duty restrictions. By one month, symptoms are much improved, and by three months symptoms have resolved completely.
The charge for a Thyroid RFA procedure ranges between $5,000 and $15,000 depending upon where it is performed. This is approximately 10% of the total charges associated with surgery.