Interventional Treatment of Thyroid Nodules and Recurrent Cancer
Why is it innovative?
About 65% of people will have at least one thyroid nodule in their lifetime, only 5% of which are cancerous. Some nodules grow slowly without causing any problems, but others grow more quickly and become large enough to cause breathing and swallowing problems and voice changes. In patients with thyroid cancer, about 20% live with recurrence of their cancer, primarily in the lymph nodes of the neck. For both groups of patients, the standard of care has been surgery to remove the part of the gland containing the benign thyroid nodule or the lymph nodes containing cancer.
With surgical treatment of nodules, however, at least 25% of patients need to take thyroid hormones for life. And patients who experience periodic cancer recurrences are subject to multiple surgeries, increasing the development of scar tissue. At NewYork-Presbyterian/Columbia University Irving Medical Center's Thyroid Center, doctors are now able to treat many of these patients without surgery by inserting an electrode or needle into the nodule or affected lymph node and destroying the tissue with radiofrequency waves or ethanol — a technique called ablation. This innovative field is called "interventional endocrinology" and is an area of expertise and leadership for NewYork-Presbyterian.
How you benefit
People who are able to receive interventional treatment for thyroid nodules or cancerous lymph nodes benefit from:
- An outpatient procedure that can be completed without surgery or general anesthesia
- Targeted treatment of diseased tissue while sparing nearby healthy tissue
- Achievement of 80% to 90% reduction in the size of benign thyroid nodules without the need for future thyroid hormone supplementation
- Effective treatment of cancer recurrence in the lymph nodes without the need for repeated surgery, which reduces the overall risks of an intervention
How does it work?
- The patient receives a local anesthetic in the neck area to reduce discomfort during the procedure.
- Guided by real-time ultrasound imaging, the doctor inserts a thin needle or electrode through the skin and advances it to the thyroid nodule or affected lymph nodes.
- For radiofrequency ablation (RFA), radiofrequency waves are applied through the needle, resulting in intense heat that destroys a small area of tissue.
- For ethanol ablation, the needle is advanced with ultrasound guidance to the area to be treated, the existing fluid is aspirated, and a small amount of 100% ethanol is injected into the nodule or lymph node. The ethanol causes inflammation that leads to very targeted destruction of the abnormal tissue.
- The patient goes home the same day as the procedure.
- Over the course of a year, the treated nodule or lymph node will shrink in size; in some cases of lymph node metastases, they can completely disappear on ultrasound. Patients who had symptoms will experience relief of their breathing, swallowing, or speech difficulties.
Is it for me?
Interventional endocrinology has the potential to revolutionize the way doctors treat benign thyroid nodules and thyroid cancer that comes back. It is not an option for everyone, but it will be an effective treatment for many people. You may be able to have interventional ethanol or RFA ablation if you have:
- Benign thyroid nodules that are causing compression in your neck that makes it challenging to breathe or swallow or changes your voice, and you choose not to have surgery or live with the risk of needing thyroid hormones.
- Recurrence of thyroid cancer in your neck lymph nodes and you do not want to have repeated surgeries to remove them.
Because it uses an electric current, RFA is not an option for people with heart arrhythmias and women who are pregnant.
What does the future hold?
The Columbia Thyroid Center is leading two clinical trials investigating the potential role of RFA to treat small papillary thyroid cancers and indeterminate thyroid nodules.
- The use of thermal ablation techniques, including RFA, has been proposed to treat small papillary thyroid cancers (less than 1.5 cm in size). The approach appears to be safe and can achieve complete disappearance of the cancer 60% of the time, based on international studies. This technique may be a better alternative to "watching and waiting" to see if these cancers grow — a surveillance approach that can make some patients anxious. Our clinical trial is one of the first in the United States to evaluate the safety and effectiveness of RFA to treat small papillary thyroid microcarcinomas.
- Researchers are studying the molecular profiles of indeterminate thyroid nodules — those that appear to be benign but have a chance of being cancerous, which make up approximately one-third of all thyroid nodules being assessed with fine-needle aspiration. Our clinical trial, currently the only one in the U.S., is evaluating the safety and effectiveness of RFA treatment for indeterminate nodules that have been molecularly tested and classified as benign.