PROCEDURES
Procedures
Who might be a candidate for nonsurgical treatment?
- Patients with benign thyroid cysts or nodules which cause compression symptoms (difficulty swallowing or breathing) or are cosmetically concerning
- Patients with “hot” toxic thyroid nodules causing hyperthyroidism (overactive thyroid)
- Patients with a solitary papillary thyroid cancer (PTC), less than 2 cm, without thyroidal extension and not close to any critical structures in the neck, and no lymph node involvement
- Patients who have already undergone thyroidectomy (full thyroid removal) who have a solitary papillary thyroid cancer (PTC) lymph node recurrence and do not wish to undergo further surgery
- Patients who are not good surgical candidates
- Patients with inoperable thyroid cancer (this is not curative and is only palliative until other treatment options can be pursued)
Who is not a candidate for nonsurgical treatment?
- Patients with follicular, medullary, or anaplastic thyroid cancer
- Patients with papillary thyroid cancer (PTC) that is larger than 2 cm and/or has metastasized
- Patients with a solitary PTC that extends outside the thyroid capsule or has lymph node involvement
- Patients with nodules that are too close to vital structures in the neck (arteries, nerves, esophagus, trachea)
Radiofrequency ablation (RFA)
- Used to treat solid and partially cystic nodules (less than 50% fluid content), toxic nodules, small papillary thyroid cancer (under 2 cm), and small lymph nodes (under 2 cm)
- Local anesthesia with lidocaine, some practitioners add conscious sedation (relaxed, but awake)
- Uses a thin probe to deliver heat into a nodule, causing tissue death, resulting in shrinking of nodules
- Uses a “moving shot” technique to treat all areas of the nodule
- Requires the use of grounding pads
- Not a candidate: Nodules that extend from the thyroid and/or are near critical structures, pregnant women, people with pacemakers (unless a bipolar electrode is used)
- May or may not be covered by insurance, but a CPT billing code is in the process of creation.
- Currently, CPT code 60699 is used, but may be insufficient.
WATCH RFA INTERVIEWS
RFA Research:
- Radiofrequency Ablation of Thyroid Nodules: Basic Principles and Clinical Application
- Use of Radiofrequency Ablation in Benign Thyroid Nodules: A Literature Review and Updates
- Efficacy on radiofrequency ablation according to the types of benign thyroid nodules
- Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the ThyroidA Systematic Review and Meta-analysis
- Update of Radiofrequency Ablation for Treating Benign and Malignant Thyroid Nodules. The Future Is Now
- The Treatment of Thyroid Cancer With Radiofrequency Ablation
- Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules—Expanding Treatment Options in the United States
- The Adoption of Ultrasound-guided Radiofrequency Ablation of Thyroid Nodules in the United States
- Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy
- Thyroid dysfunction following radiofrequency ablation for benign thyroid nodules: more likely to occur within one-week and in high-risk population
- Significance of radiofrequency ablation in large solid benign thyroid nodules
- Current Status and Challenges of US-Guided Radiofrequency Ablation of Thyroid Nodules in the Long Term: A Systematic Review
- Radiofrequency ablation for benign thyroid nodule treatment: New solution in our center
- Radiofrequency ablation for thyroid nodules in Ecuador: a cross-sectional study
- Radiofrequency ablation versus reoperation for benign thyroid nodules that developed after previous thyroid surgery
- From ablation to operation: Unraveling the surgical outcomes and complications of thyroidectomy after radiofrequency ablation
- Radiofrequency Ablation for Benign Symptomatic Thyroid Nodules in the Netherlands: Successful Introduction of a Minimally Invasive Treatment Option Improving Quality of Life
- Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan
- Quality of Life and Cost-Effectiveness of Radiofrequency Ablation versus Open Surgery for Benign Thyroid Nodules: a retrospective cohort study
- Efficacy and safety of ultrasound (US)-guided radiofrequency ablation of benign thyroid nodules
- Radiofrequency Ablation of Thyroid Nodules: A Long-Term Prospective Study of 24 Patients
- Thyroid Nodules Treated with Percutaneous Radiofrequency Thermal Ablation: A Comparative Study
- US-Guided Percutaneous Radiofrequency versus Microwave Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study
- Ultrasound-Guided Radiofrequency and Microwave Ablation for the Management of Patients With Benign Thyroid Nodules: Systematic Review and Meta-Analysis
- Clinical and functional results of radiofrequency ablation and microwave ablation in patients with benign thyroid nodules
PEI / Ethanol ablation
- Used to treat thyroid cysts and cystic components of partially cystic nodules
- Was previously used to treat solid nodules and lymph nodes, but is not typically recommended, now that thermal ablation options are available
- Local anesthesia with lidocaine
- Ethanol is injected into a cyst using a very small needle
- Ethanol causes the lining of the cyst to die so that it no longer refills with fluid
- CPT billing code: 60300
WATCH PEI INTERVIEWS
PEI Research:
- Percutaneous laser ablation for benign and malignant thyroid diseases
- Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients
- Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA)
- Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients
- Effects of Ultrasound-Guided Laser Ablation Therapy on Symptomatic Benign Thyroid Nodules, Using EchoLaser – Results of a Pilot Study in the United States
- 2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma
- Effects of percutaneous laser ablation treatment in benign solitary thyroid nodules on nodule volume, thyroglobulin and anti-thyroglobulin levels, and cytopathology of nodule in 1 yr follow-up
- The value of ultrasound guided laser ablation in papillary thyroid recurrence carcinoma: A retrospective, single center study from China
- Microwave Ablation Compared With Laser Ablation for Treating Benign Thyroid Nodules in a Propensity-Score Matching Study
- The relationship between ablation range and ablation energy in papillary thyroid microcarcinoma: a comparison between microwave ablation and laser ablation
Laser ablation
- Delivers focused light energy through optical fibers, which is converted into heat
- Used to treat solid and partially cystic nodules, toxic nodules, small papillary thyroid cancer (under 2 cm), and small lymph nodes (under 2 cm)
- Local anesthesia with lidocaine
- Uses a thin fiber (inserted into a stationary needle guide) inserted into one or more nodules simultaneously
- Not a candidate: Nodules that extend from the thyroid and/or are near critical structures
- CPT billing code: 0673T
WATCH LASER INTERVIEWS
LASER Research:
- Percutaneous laser ablation for benign and malignant thyroid diseases
- Percutaneous Ultrasound-Guided Laser Ablation of Benign Thyroid Nodules: Results of 10-Year Follow-Up in 171 Patients
- Benign thyroid nodules treatment using percutaneous laser ablation (PLA) and radiofrequency ablation (RFA)
- Ultrasound-guided percutaneous laser ablation for papillary thyroid microcarcinoma: a retrospective analysis of 37 patients
- Effects of Ultrasound-Guided Laser Ablation Therapy on Symptomatic Benign Thyroid Nodules, Using EchoLaser – Results of a Pilot Study in the United States
- 2022 Expert consensus on the use of laser ablation for papillary thyroid microcarcinoma
- Effects of percutaneous laser ablation treatment in benign solitary thyroid nodules on nodule volume, thyroglobulin and anti-thyroglobulin levels, and cytopathology of nodule in 1 yr follow-up
- The value of ultrasound guided laser ablation in papillary thyroid recurrence carcinoma: A retrospective, single center study from China
- Microwave Ablation Compared With Laser Ablation for Treating Benign Thyroid Nodules in a Propensity-Score Matching Study
- The relationship between ablation range and ablation energy in papillary thyroid microcarcinoma: a comparison between microwave ablation and laser ablation
Microwave ablation (MWA)
- Uses electromagnetic field to cause oscillation of polarized particles to generate heat through particle collision
- Local anesthesia with lidocaine, some practitioners add conscious sedation (relaxed, but awake)
- Uses a thin probe to deliver heat into a nodule, causing tissue death, resulting in shrinking of nodules
- Uses a “moving shot” technique to treat all areas of the nodule
- Can be used to treat larger thyroid nodules in a shorter amount of time
WATCH MWA INTERVIEWS
MWA Research:
- US-Guided Percutaneous Radiofrequency versus Microwave Ablation for Benign Thyroid Nodules: A Prospective Multicenter Study
- Long-term outcome of microwave ablation for benign thyroid nodules: Over 48-month follow-up study
- Ultrasound-guided microwave ablation for benign thyroid nodules results in earlier and faster nodule shrinkage in patients with Hashimoto’s thyroiditis than in those with normal thyroid function
- Multiple overlapping microwave ablation in benign thyroid nodule: a single-center 24-month study
- Microwave Ablation Vs Traditional Thyroidectomy for Benign Thyroid Nodules: A Prospective, Non-Randomized Cohort Study
- Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center, large cohort study
- A study on the efficacy of microwave ablation for benign thyroid nodules and related influencing factors
- Conspicuousness and recurrence related factors of ultrasound-guided microwave ablation in the treatment of benign thyroid nodules
- Microwave ablation compared to thyroidectomy to treat benign thyroid nodules
- Microwave Ablation Compared With Laser Ablation for Treating Benign Thyroid Nodules in a Propensity-Score Matching Study
- Safety and efficacy of microwave ablation for benign thyroid nodules and papillary thyroid microcarcinomas: A systematic review and meta-analysis
- Ultrasound-Guided Radiofrequency and Microwave Ablation for the Management of Patients With Benign Thyroid Nodules: Systematic Review and Meta-Analysis
- Protect the recurrent laryngeal nerves in US-guided microwave ablation of thyroid nodules at Zuckerkandl tubercle: a pilot study
- Contemporary Thyroid Nodule Evaluation and Management
- Clinical and functional results of radiofrequency ablation and microwave ablation in patients with benign thyroid nodules
- The relationship between ablation range and ablation energy in papillary thyroid microcarcinoma: a comparison between microwave ablation and laser ablation
- Microwave Ablation versus Surgical Resection for Solitary T1N0M0 Papillary Thyroid Carcinoma
Cryoablation
- Uses circulating cooled fluids which rapidly expand into gas
- More often used to treat thyroid cancer metastases
WATCH CRYOABLATION INTERVIEWS
CRYOABLATION Research:
- Cryoablation of goiter irrespective of thyroid profile
- Salvage Cryoablation for Local Recurrences of Thyroid Cancer Inseparable from the Trachea and Neurovascular Structures
- Percutaneous cryoablation of follicular thyroid carcinoma metastasis to the pancreas
- Safety and Efficacy of Percutaneous Cryoablation of Extraspinal Thyroid Cancer Bone Metastases with Curative Intent: Single-Center Experience with a Median Follow-up of More than 5 Years
- Feasibility and Safety of Single-Probe Cryoablation with Liquid Nitrogen: An Initial Experience in 24 Various Tumor Lesions
- CT guided cryoablation for locally recurrent or metastatic bone and soft tissue tumor: initial experience
Thyroid Arterial Embolization (TAE)
- Utilized for treatment of very enlarged goiters, substernal goiters (below the collarbone or sternum), or Graves Disease
- Conscious sedation (relaxed, but awake)
- A catheter in the artery (groin or wrist) is used to access the blood vessels which feed the thyroid gland
- Small particles are injected that are specifically designed to block this artery
- Allows the entire thyroid gland to reduce in size
- CPT billing code: 37243
WATCH TAE INTERVIEWS
TAE Research:
- Thyroid ima artery embolization for the treatment of Graves’ disease and thyroid storm
- Arterial Embolization: A Novel Approach to Thyroid Ablative Therapy for Graves’ Disease
- Thyroid arterial embolization in a patient with congenital heart disease and refractory amiodarone-induced thyrotoxicosis
- Thyroid Artery Embolization for Nodular Goiter: The Optimal Candidates and Techniques Have Yet To Be Determined
- Thyroid Arterial Embolization to Treat Graves’ Disease
- Evaluation of selective embolization of thyroid arteries (SETA) as a preresective treatment in selected cases of toxic goitre
- Thyroid artery embolization of large solitary symptomatic benign thyroid nodules through transradial approach
- Thyroid arterial embolization as a therapeutic option for hyperthyroidism: a case series
Nanosecond Pulsed Field Ablation (nsPFA)
- Performed with local anesthesia (lidocaine) or sedation
- Uses nanosecond pulses of electrical energy to ablate soft tissue
- Targets cellular tissue without damaging surrounding non-cellular structures (nonthermal ablation)
- Treats benign thyroid nodules
- Not intended for use on nodules extending beyond the thyroid
WATCH nsPFA INTERVIEWS
Disclaimer: None of the statements made here should be considered medical advice. We are patients, not doctors. You must seek the guidance of a physician who has been specifically trained in these procedures. Additionally, it is beneficial to get the opinions of multiple doctors when making decisions that can impact the rest of your life. Educate yourself on the risks and benefits so you can make informed decisions about your healthcare.
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