Thyroid Procedures

Surgical Solutions Network – Clearpoint Surgical Toronto Interventional Thyroid Program

What are Interventional Thyroid Procedures?

Interventional thyroid procedures are a novel way to treat diseases of the thyroid through the skin without having to make any incisions. Ultrasound is used to guide less invasive techniques, often using small needles, making the procedure less invasive. 

 The most commonly performed procedures include ultrasound-guided radiofrequency ablation (RFA) and ultrasound-guided ethanol ablation of specific types of benign thyroid nodules, and sometimes malignant thyroid nodules. In addition, we offer molecular testing of indeterminate nodules to help patients and clinicians decide on the optimal treatment pathway.  

Who Performs Interventional Thyroid Procedures?

Many different types of specialists can perform interventional thyroid procedures including: Head & Neck Surgeons, Endocrinologists and Radiologists. At Surgical Solutions Network in Toronto, your procedure will be performed by highly trained Head & Neck Surgeons.

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. Radiofrequency ablation of thyroid tissue has been performed since 2002 and is best used in cases of benign thyroid nodules that cause symptoms (e.g. neck swelling, neck pressure, sensation of a lump in the throat, etc.) or are hyperfunctioning (making too much thyroid hormone). For these patients, ultrasound-guided radiofrequency ablation provides a safe and effective alternative to surgery. 

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 lesion. This procedure has been very successful for treating cystic (fluid-filled) thyroid nodules. 

Treatment of thyroid cysts is considered when compressive symptoms are present (i.e. difficulty swallowing, difficulty breathing, visible lump on the neck, etc.) 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, requires an incision on the neck, and carries a10-25% risk of hypothyroidism.  In addition, some patients are not able to have surgery due underlying medical conditions. For these patients, ultrasound-guided ethanol ablation is a safe and effective option for treating thyroid cysts. 

What is Molecular Testing of Indeterminate Nodules? 

Molecular testing of thyroid nodules is a test that helps patients and their clinicians make important management decisions with respect to thyroid nodules. Many patients who have a thyroid nodule have a test called a fine needle aspiration biopsy of the nodule, where a clinician uses an ultrasound to guide a small needle into the nodule to remove some cells to determine if the nodule is benign or malignant (cancerous).  However, fine needle aspiration can often lead to results that are called indeterminate, which means the pathologist looking at the cells is unable to say whether the nodule is benign or malignant.  When this occurs patients have a variety of options including actively monitoring the nodule with their doctor, repeating a fine needle aspiration biopsy, doing surgery to remove the nodule to determine if it is benign or cancerous, or performing molecular testing. 

Molecular testing is similar to a fine needle aspiration biopsy, where a physician uses an ultrasound to guide a small needle into the thyroid nodule.  The cells are then analyzed for their molecular signature rather than just their appearance, to help determine whether the nodule is more likely to be benign or malignant.  This important information can then help patients and their doctors decide on how to best manage the nodule, offering a more personalized approach to treatment. 

How Are These Procedures Performed? 

These procedures are performed as an outpatient procedure in a specially equipped room in our facility.  The patient is given local anesthesia and is awake for the procedure. The doctor will work with the patient and their healthcare team to safely stop any blood thinners or aspirin prior to the day of the procedure, if required.  

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 These Procedures? 

Like any other procedure, ultrasound-guided techniques can be associated with a small risk (<0.5 – 1%) of potential complications. Fortunately these are almost all temporary.  

These include: 

• Infection  
• Bleeding 
• Vomiting 
• Skin Burn 
• Voice Change 
• Hypothyroidism 
• Nerve injury  

Next Steps: Book Your Interventional Thyroid Procedure Consultation

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 using our online form to learn more and request a consultation today. To discover your health options, your patient advisor will discuss:

• Your medical history
• Potential risks and complications