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Interventional Endocrinology - non-surgical treatments for neck nodules and cysts

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.

What Is Ultrasound-guided Radiofrequency Ablation (RFA)?

Radiofrequency ablation uses a small needle that creates very precise radio waves that heat up and destroy a small area of tissue. 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 in the US since 2002 and in our office since 2021. It is best used in cases of recurrent thyroid cancer where surgery is not ideal, or symptomatic benign thyroid nodules, or parathyroid adenoma in patients who cannot undergo surgery. For these patients, ultrasound-guided radiofrequency ablation provides a safe and effective alternative when surgery is not an ideal choice.

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 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 an outpatient procedure 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 the same day of their procedure.

What Complications Are Associated With The Procedures?

Like any other procedure, ultrasound-guided techniques can be associated with a small risk of potential complications. These include: infection, bleeding, (temporary) changes to your voice, (temporary) hypothyroid. These are theoretical risks - their likelihood is extremely small.

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 allows him to offer the best and appropriate treatment for patients with thyroid disorders.

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