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SANDIENDO
San Diego Center for Interventional Endocrinology
La Jolla, San Diego, California

What Is Interventional Endocrinology?

Interventional endocrinology is an emerging field that uses percutaneous (i.e. through the skin), image-guided procedures to treat endocrine diseases. Interventional endocrinology uses less invasive techniques, often a simple needlestick, than the typically surgeries which often treat these conditions.

The most commonly performed procedures include ultrasound-guided ethanol ablation and ultrasound-guided radiofrequency ablation (RFA) of specific types of benign thyroid nodules and lymph nodes with recurrent cancer (i.e. cancer that came back after having been treated with surgery).

 

Who Performs Interventional Endocrinology Procedures?

Many different types of specialists can perform interventional endocrinology procedures including endocrinologists and endocrine surgeons. However, these procedures require unique, specialized training to be performed safely and with good results. Equally important, a multidisciplinary discussion among the specialists is critical to determining if a patient is a good candidate for the procedure. We at "Diabetes and Endocrine Specialists" work closely with head and neck surgeons who are leaders in their field (Dr. Perry Mansfield at "Senta Clinic", Dr . Mark Sherman at "Scripps", Dr. Michael Bouvet at "UC San Diego").

 

What Is Ultrasound-guided Ethanol Ablation?

Ultrasound-guided ethanol ablation uses high-resolution ultrasound to guide the injection of a small amount of ethanol into a thyroid nodule or lymph node. The ethanol causes an inflammatory response that leads to very targeted destruction of the nodule or node. This procedure has been very successful for treating cystic (fluid-filled) thyroid nodules, since simple cysts are almost never cancer (<1 percent) and partially cystic nodules with no suspicious features that have a very low risk of cancer (< 3 percent risk of malignancy).

Treatment of thyroid cysts is considered when compressive symptoms are present (i.e. difficulty swallowing, difficulty breathing, or voice changes) or when the cyst is very large. Traditional options for treating thyroid cysts include needle aspiration (drainage of the cyst through the skin using a small needle) or surgical removal. Unfortunately, needle aspiration has a high chance of the cyst coming back (60-90%). Surgery cures the problem, but it can be associated with a low risk of complications and a very small group of patients may not be able to have surgery due to other medical problems. For these patients, ultrasound-guided ethanol ablation is a safe and effective option for treating thyroid cysts.

Radiofrequency Ablation (RFA) and Percutaneous Laser Ablation (PLA)

 

We are proud to be the first center in San Diego to offer ultrasound-guided Radiofrequency Ablation (RFA) and Percutaneous Laser Ablation (PLA) of thyroid nodules as alternatives to surgery for symptomatic benign thyroid nodules!

 

Our brains, our hearts, and our digestive and metabolic systems function normally with the help of one small gland: the thyroid gland. 

Nodules on the thyroid gland, however common, can interfere with the proper functioning of the thyroid gland; Benign nodules can cause swallowing difficulty, excessive hormone production, and pressure symptoms within the neck. 

 

What are thyroid nodules and who is at risk?
A thyroid nodule is a growth of thyroid tissue or a fluid-filled cyst that forms a lump in the thyroid gland. Thyroid nodules are fairly common.  In fact, about 75% of all individuals will have a nodule on their thyroid gland during their lifetime and may not even know it.

The problems occur when thyroid nodules grow to a size that interferes with breathing and swallowing or affects the physical aspects of a patient’s appearance that they find unappealing.  

Traditionally, thyroid surgery or radioactive iodine would have been the only treatment options for problematic thyroid nodules, depending on what the problem is: until now.

Thyroid radiofrequency ablation (RFA) is a novel treatment that is highly successful in reducing the size of thyroid nodules.

Thyroid Radiofrequency Ablation: An Advanced, Non-Surgical Treatment of Thyroid Nodules

A common practice in other countries, radiofrequency ablation (RFA) is now available at Diabetes and Endocrine Specialists in La Jolla. This non-surgical alternative shrinks the nodules without compromising thyroid function and helps avoid surgery.

 

What are Radiofrequency Ablation / Laser Ablation?
Radiofrequency and Laser Ablation are medical procedure where thyroid nodules are being ablated (destroyed) using heat generated from alternating current or from laser light, passed from the generator to the tissue via a probe. Performed under local anesthesia, both radiofrequency and laser ablation are relatively painless and do not require general anesthesia.

 

Dr. Schneider will use guided ultrasound to insert one probe (RFA) or two probes (PLA) into the thyroid nodule. Through selective heating of the probe tip, the nodule is destroyed. The cauterized tissue is then broken down by the body over the course of 9-12 months.

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How does Radiofrequency Ablation work?

Radiofrequency ablation (RFA) uses a small needle (left) that creates very precise radio waves that heat up and destroy a small area of tissue (right). RFA is frequently used to destroy cancer cells in the liver, lung, kidney, breast, and bone, as well as to kill nerve cells that cause chronic pain. Radiofrequency ablation of thyroid tissue has been performed worldwide since 2002 and is best used in cases of symptomatic benign thyroid nodules.

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How does Percutaneous Laser Ablation work?

For very large nodules, we have the option to use Percutaneous Laser Ablation.

PLA  is using laser light delivered through an optic fiber via a needle inserted into the nodule. The laser energy is causing heat-induced ablation of the nodule. Laser ablation is using less energy than RFA, making it more precise but also slower in achieving results. 

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How effective is Thyroid RFA for large benign solid thyroid nodules?

Thyroid RFA is considered successful when the nodule shrinks by >50%. On average, thyroid RFA shrinks solid thyroid nodules by 80%, with a range of 65-94%, so the results are usually really good (see photo below: left before RFA, right 6 months after RFA).

Sometimes, the nodules disappear completely. Almost all patients have great symptomatic improvement, with complete or almost complete resolution of their compressive symptoms and/or cosmetic concerns. Significantly more than half the patients (around 80-90%) will do well with a single RFA session. A minority of patients with very large nodules may require more than one RFA session, to achieve the best outcomes and prevent future re-growth.

For hyperfunctioning thyroid nodules, the volume reduction is similar, and hyperthyroidism eventually resolves in 50-80% of the patients.

It is important to note that thyroid RFA does not lead to these results immediately. There is significant tumor reduction within a month after the treatment, but the nodules continue to gradually shrink for up to a year after the RFA procedure.

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How is RFA performed?
The procedure is performed in our La Jolla office. Patients are awake during the entire time and are able to breathe and speak. After the neck region is numbed with a local anesthesia injection, Dr. Schneider will insert, under continuous ultrasound guidance, a small needle into the thyroid nodule and move the needle within the nodule (moving shot technique) until the entire nodule is “ablated”. The duration of the RFA procedure is about 15 to 30 minutes, depending on the nodule size. After a brief observation time, patients can resume their normal activities on the same day of their procedure. No hospitalization and no general anesthesia are needed.

 

What are the advantages and risks of the RFA procedure?
RFA is a very gentle, minimally invasive procedure and does not require general anesthesia or a hospital stay. There is no neck scar and recovery time is very short. RFA spares the healthy thyroid tissue: lifelong thyroid hormone dependency, as oftentimes seen after neck surgery, is usually not necessary.

RFA has a very low complication rate similar to a fine needle aspiration biopsy. Relevant surgical risks, such as damage to the voice box nerve or parathyroid glands, are virtually nonexistent.

What is the cost of Thyroid RFA?

Our focus is making thyroid RFA safe, effective, accessible, and affordable. We do this by eliminating or minimizing the costs associated with a hospital, surgical center, and anesthesia.

At Diabetes and Endocrine Specialists, the RFA procedure is performed in the office with local anesthesia only. The cost of thyroid RFA at DES without insurance coverage is between $3,500 and $4,500. However, we will work with your insurance company to determine coverage, benefits, and out-of-pocket cost. Make sure to ask us for a 2nd opinion before committing to surgery or RFA with another physician.

How Can Interventional Endocrinology Help with Recurrent Thyroid Cancer?

Although the overall survival for patients with thyroid cancer is excellent, up to 20% of patients will have the recurrent disease (i.e. cancer that comes back) even with appropriate initial surgical treatment. The vast majority of these recurrences are found in the lymph nodes (90%). Although surgery remains the preferred treatment for recurrent disease, the chance of complications increases because of the scar tissue created in previous operations. Both ultrasound-guided ethanol and radiofrequency ablation have proven to be safe and effective procedures for recurrent thyroid cancer.

 

How Are These Procedures Performed?

These procedures are performed as outpatient procedures in a special room in our office in La Jolla. The patient is given local anesthesia and is awake for the procedure. We will work with the patient and their healthcare team to safely stop any blood thinners or aspirin prior to the day of the procedure. Patients can eat normally up until the procedure and there are no restrictions after the procedure except to avoid heavy lifting for the day. Patients can resume normal activities on the same day of their procedure.

Am I A Good Candidate For These Interventional Procedures?

If you are interested in either radiofrequency ablation or ethanol ablation and would like to see if you would be a good candidate, please contact us at (858) 622-7200.

The "Interventional Endocrinology" program at "Diabetes and Endocrine" is a natural extension of our successful endocrine practice. Dr. Schneider has unparalleled expertise in clinical thyroidology and ultrasonography and was trained by a pioneer of ultrasound-guided interventional techniques, Dr. Korkusuz in Frankfurt (Germany). His combined expertise in clinical thyroidology, interventional treatment of thyroid disorders, and highly advanced ultrasonographic skills paired with state-of-the-art imaging technology allow him to offer the best and most appropriate treatment for patients with thyroid disorders.

For all questions, please schedule a consultation with Dr. Schneider. We are happy to assist with nearby (walking distance) accomodations if you are travelling from outside of San Diego.

Attached, please find our patient RFA brochure: 

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