Minimally Invasive Thyroid Procedures

Interventional endocrinology is an emerging field that uses percutaneous (pinhole through the skin) image-guided procedures to treat endocrine diseases. These are minimally invasive techniques that will prevent a more invasive procedure like surgery, and thus preventing hospital stays and major complications.

The most procedures include:

  • Percutaneous ethanol injections (PEI) for recurrent simple thyroid cysts
  • Ultrasound guided Laser ablation (LA)
  • Ultrasound guided Radiofrequency ablation (RFA)

Unique Multi-Disciplinary Approach

At Miami Diabetes and Endocrinology, we are proud to offer the most advanced therapies for the treatment of thyroid nodular disease. We are the only practice in South Florida that combines the extensive procedural image-guided expertise of Dr. Gonzalez-Beicos (Interventional Radiology) and the vast research and clinical expertise of Dr. Manzano (Endocrinology) when it comes to managing thyroid nodular disease. Cases are methodically reviewed conjointly by both physicians to tailor the most appropriate treatment plan for the patient. You will feel comfortable before, during and after the procedure as you will be carefully guided though the process, making sure that your expectations are met.

What is a Thyroid Nodule?

Thyroid nodules are an abnormal overgrowth of tissue in the thyroid gland (located in the front of your neck). These nodules can be solid or fluid-filled, also called cyst. Nodules on your thyroid are extremely common, especially in females. Luckily, 95% of all thyroid nodules are benign (non-cancerous).

What is Laser Ablation (LA) for thyroid nodules?

After injecting local anesthetic into the skin, a very small needle is introduced through the skin into the thyroid nodule under ultrasound image guidance. A laser fiber is then advanced though the hollow needle and the tip of the laser exposed inside the nodule. A generator then delivers laser energy into the tissue which results in localized heat that destroys the cells in the nodule, inducing progressive reduction of its size and consequently the resolution of symptoms.

What is radiofrequency ablation (RFA) for thyroid nodules?

After injecting local anesthetic into the skin, a small needle-electrode is introduced through the skin into the thyroid nodule under ultrasound image guidance. Using a radiofrequency generator, your doctor allows a carefully controlled amount of energy to flow through the electrode into the tissue generating heat that destroys the cells of in the nodule. The nodule degenerates and eventually shrinks.

What are the benefits from ablation procedures for thyroid nodules?

  • Performed as an out-patient procedure, which means no downtime or hospitalization.
  • Minimally invasive procedure.
  • Performed under local anesthesia.
  • Shorter recovery times.
  • No scarring.
  • Volume reduction of the nodule.
  • Low complication rate.
  • Preserves your healthy thyroid tissue.
  • Allows your thyroid to function normally without the need for a lifetime of medication.

What are the risks of ablation procedures for thyroid nodules?

Although risks or complications are very unlikely, your doctor will review them in length before any intervention. Below are some key points:

The main risks are: bleeding, hoarse voice due to nerve bruising, skin burns and infection. Infection can be a delayed problem and present with swelling, pain and redness.

Rare serious complications can include: damage to the food pipe (esophagus), air pipe (trachea) and nerves to the voice box (vocal cords). The risk of permanent injury to the voice box nerve leading to alteration in the voice is less than 1% (less than 1 in 100).

Larger nodules could require more than one treatment for effective nodule shrinkage. Your doctor will discuss the likelihood of needing additional treatments with you during your initial consultation.

How do I prepare for an ablation procedure for thyroid nodules?

During the initial consultation, your doctor will review any current medications you are taking and provide further instructions, if needed. Other than blood thinners, which you will likely need to stop taking a few days prior to the procedure, most medications do not interfere with the procedure.

Are the ablation procedures for thyroid nodules done in the office setting and are they painful?

Yes! This is an office-based procedure, with a short recovery period. Because local anesthesia is administered before the procedure, very few patients experience any pain at all. Following your treatment, over the counter pain control agents can help with any discomfort. Local icepacks will be used right after the procedure has concluded.

What is the success rate of ablation procedures for thyroid nodules?

Since each case is different, your doctor will determine your expected size reduction on your initial consultation. The average size reduction is 40-60% reduction after 3 months and approximately a 60-90% reduction after one year.

Are the ablation procedures for thyroid nodules FDA approved and will my insurance pay for it?

The procedure is FDA approved. There is a vast number of articles predominantly in Europe and Korea. However, the scientific evidence is growing very fast in the rest of the world including the US. Because these are relatively new procedures in the US, Medicare and private insurances usually do not cover them. However, the cost of the procedure is not prohibitive, and we offer payment plans for your convenience.

Can Radiofrequency ablation or Laser Ablation be used on recurrent simple thyroid cysts?

Percutaneous Ethanol Injection (PEI) should preferentially be considered as the first-line treatment for releasing thyroid cysts. This is done by introducing a small needle into the cyst cavity under ultrasound image guidance and filling it with absolute alcohol. The alcohol then destroys the fluid producing cells lining the inside of the cyst, thus preventing the cyst to fill again with fluid and eventually disappear.