Thyroid Nodule

Ablation Therapy in Thyroid Nodules

Thyroid nodules are seen in a high rate of 30-40% in the population. These nodules can be solid (solid), liquid (cystic), warm (hyperactive), cold (hypoactive), benign (benign) or malignant (malignant). The probability of nodules becoming cancerous is between 5-10%.

All benign nodules can be ablated. In this respect, it does not matter whether the nodules are solid-liquid, hot-cold, single or multiple. In very large nodules, the procedure may need to be repeated or the patient may prefer surgery. In thyroid cancer cases, if the nodule size is less than 2 cm and there is no spread to the lymph nodes, complete treatment is provided by ablation.

Before the ablation procedure, an ultrasonographic examination should be performed by an experienced radiologist to evaluate the cancer risk and size of the nodule. A biopsy must also be performed after this evaluation. The patient is interviewed before the procedure and given detailed information about the advantages and possible risks of the procedure.

The procedure is performed under ultrasound guidance. Our anesthesiologist is also present during the procedure and gives the patient light sedation (tranquilizer) by opening an intravenous line, and also controls the pulse and blood pressure. Thus, we ensure that the procedure is more comfortable and safe. After giving local anesthesia to the skin and thyroid gland capsule, we enter the nodule to be burned with microwave or radiofrequency system and ablation is applied between 10-40 minutes depending on the size and number of nodules.

After the procedure is over, ice is applied to the neck area. Our patient is sent home after resting for about 30 minutes and can eat after about an hour. It is also recommended to take painkillers for 5 days.

After the procedure, ultrasonographic controls are performed at 1, 3, 6 and 12 months and then annually. Nodules usually shrink by 30-50% in one month and 60-80% in one year. Sometimes some nodule tissue may be left unburned after the procedure to protect the surrounding nerves and important structures, or some living tissue may remain in very large nodules. These remaining tissues can be ablated if necessary after one year of follow-up. In addition, re-growth of the nodule may occur in 10% of patients over the years. In this case, the ablation procedure can be easily repeated.

Main Advantages of Ablation Procedure:

• No skin incision is made.
• It is performed under local anesthesia and mild sedation.
• The procedure is usually performed in a short period of 10-30 minutes.
• After the procedure, the patient is sent home after resting for a while.
• Since the thyroid gland is not removed, the patient does not become dependent on thyroid medication for life.

Possible Risks and Complications:

• In experienced hands, complications related to the ablation procedure are very rare.
• Hoarseness: It is less common than surgery. It develops around 1%. It is mostly temporary. It is immediately noticeable because the patient is spoken to during the procedure. Cold sugar water (5% dextrose) and steroids are given around the nerve and in most cases immediate improvement is achieved.
• Bleeding The thyroid gland is a very bloody organ. Bleeding may rarely occur between the skin and the thyroid gland during the procedure. This is usually a limited bleeding. Ice is applied and painkillers are given for treatment. It may cause pain in the patient and may cause problems such as bruising in the neck in the following days. However, it is not a permanent problem.
• Infection: Rarely, infection and abscess may develop. In this case, antibiotics are given and the accumulated fluid is drained if possible. It resolves in a short time with appropriate treatment.