Guzki tarczycy – Leczenie

Guzki tarczycy
Leczenie

Guzki tarczycy występują u około 50% populacji, z przewagą zmian łagodnych, które najczęściej nie wymagają leczenia, a jedynie regularnej obserwacji klinicznej i ultrasonograficznej co 6-12 miesięcy. Kluczową rolę w ocenie ryzyka złośliwości pełni biopsja aspiracyjna cienkoigłowa (BAC). Leczenie farmakologiczne supresyjne lewotyroksyną nie jest obecnie zalecane ze względu na ograniczoną skuteczność i ryzyko działań niepożądanych. W przypadku guzków nadczynnych stosuje się leki przeciwtarczycowe (metimazol, propylotiouracyl) oraz beta-blokery, a także terapię radiojodem (I-131) lub leczenie chirurgiczne, zależnie od odpowiedzi na leczenie i objawów. Chirurgia (lobektomia lub tyroidektomia totalna) jest wskazana przy guzach złośliwych, dużych guzach uciskowych, guzkach nadczynnych opornych na leczenie farmakologiczne oraz zmianach kosmetycznie uciążliwych, z koniecznością dożywotniej suplementacji hormonów po tyroidektomii.

Leczenie guzków tarczycy

Guzki tarczycy są bardzo częstą patologią, występującą u nawet 50% populacji. Większość z nich ma charakter łagodny i nie wymaga leczenia. Sposób postępowania z guzkami tarczycy zależy od ich typu, wielkości, objawów klinicznych oraz wyniku biopsji aspiracyjnej cienkoigłowej (BAC), która odgrywa kluczową rolę w ocenie ryzyka złośliwości i wyborze metody leczenia¹².

Obserwacja guzków łagodnych

W przypadku gdy biopsja wykazuje łagodny charakter guzka tarczycy, najczęściej zaleca się strategię uważnej obserwacji. Pacjent powinien być regularnie monitorowany przez lekarza z wykorzystaniem badania fizykalnego oraz badania ultrasonograficznego co 6-12 miesięcy. Jeśli guzek nie rośnie i nie powoduje objawów uciskowych, może nigdy nie wymagać leczenia³⁴.

Regularne monitorowanie obejmuje:⁵⁶:
– Badanie fizykalne
– Badanie ultrasonograficzne tarczycy
– Badania laboratoryjne oceniające funkcję tarczycy
– W przypadku wzrostu guzka – powtórną biopsję

Leczenie farmakologiczne

Leczenie hormonalne (supresyjne) z wykorzystaniem lewotyroksyny było stosowane w przeszłości w celu zmniejszenia wielkości guzków, jednak obecnie nie jest zalecane przez Amerykańskie Towarzystwo Tyreologiczne. Badania wykazały, że tylko niewielki odsetek guzków ulega zmniejszeniu pod wpływem terapii supresyjnej, a leczenie to może wiązać się z działaniami niepożądanymi, takimi jak zaburzenia rytmu serca czy utrata wapnia z kości⁷⁸.

W przypadku guzków nadczynnych (wydzielających nadmiar hormonów tarczycy) stosuje się leki przeciwtarczycowe, takie jak⁹¹⁰:
– Metimazol (Thyrozol)
– Propylotiouracyl
– Beta-blokery w celu złagodzenia objawów nadczynności tarczycy

Leczenie farmakologiczne może być stosowane jako terapia przygotowująca do leczenia definitywnego (chirurgicznego lub radiojodem) lub jako leczenie długoterminowe, choć nie prowadzi do wyleczenia nadczynności tarczycy¹¹.

Leczenie chirurgiczne

Zabieg chirurgiczny może być zalecany w następujących przypadkach¹²¹³:

– Guzki złośliwe lub podejrzane o złośliwość
– Duże guzki powodujące objawy uciskowe (trudności w oddychaniu lub połykaniu)
– Guzki nadczynne, które nie reagują na leczenie farmakologiczne
– Duże guzki będące przyczyną defektów kosmetycznych

Rodzaje zabiegów chirurgicznych obejmują¹⁴¹⁵:

– Lobektomia (usunięcie części tarczycy) – przy pojedynczych guzkach łagodnych lub małych rakach
– Tyroidektomia totalna (całkowite usunięcie tarczycy) – przy większych guzach złośliwych lub mnogich zmianach guzowatych

Po całkowitym usunięciu tarczycy pacjent wymaga dożywotniej suplementacji hormonami tarczycy¹⁶. Powikłania operacji mogą obejmować uszkodzenie nerwu krtaniowego, niedoczynność przytarczyc, krwawienie i zakażenie¹⁷.

Terapia jodem radioaktywnym

Leczenie radioaktywnym jodem (I-131) jest skuteczną metodą stosowaną głównie w przypadku¹⁸¹⁹:

– Guzków nadczynnych (tzw. „gorących”)
– Wola guzkowego nadczynnego
– Uzupełniająco po operacji raka tarczycy (w przypadku raków zróżnicowanych)

Pacjent otrzymuje jod radioaktywny w formie kapsułki lub płynu. Tarczyca wychwytuje radioaktywny jod, co prowadzi do zniszczenia tkanki gruczołowej i zmniejszenia wielkości guzków. Efekty leczenia są widoczne w ciągu kilku tygodni lub miesięcy²⁰.

Skutki uboczne tej terapii mogą obejmować²¹:
– Uszkodzenie gruczołów ślinowych powodujące suchość w ustach
– Uszkodzenie przewodów łzowych wywołujące zespół suchego oka
– Wywoływanie trwałej niedoczynności tarczycy wymagającej suplementacji hormonalnej

Terapia radiojodem nie jest skuteczna w przypadku raków rdzeniastych i anaplastycznych tarczycy, które nie wychwytują jodu²².

Nowoczesne metody małoinwazyjne leczenia guzków tarczycy

Ablacja termiczna

W ostatnich latach rozwinęły się małoinwazyjne metody leczenia guzków tarczycy, które stanowią alternatywę dla tradycyjnej chirurgii i leczenia radiojodem²³.

Ablacja prądem o częstotliwości radiowej (RFA)

Metoda ta wykorzystuje energię cieplną dostarczaną przez elektrody w celu zniszczenia tkanki guzka. Procedura przeprowadzana jest pod kontrolą USG, przez przezskórne wprowadzenie cienkiej elektrody do guzka²⁴.

Główne zalety ablacji RFA²⁵²⁶:
– Procedura ambulatoryjna wykonywana w znieczuleniu miejscowym
– Zachowanie prawidłowej funkcji tarczycy (brak konieczności suplementacji hormonalnej)
– Szybki powrót do normalnej aktywności (zwykle następnego dnia)
– Brak widocznej blizny (jedynie nakłucie skóry)
– Znacząca redukcja objętości guzka (60-90% w ciągu kilku miesięcy)

Badania kliniczne wykazały, że ablacja RFA prowadzi do zmniejszenia objętości guzka średnio o 44,6% w ciągu pierwszych 8,6 miesięcy obserwacji. Po dłuższym okresie obserwacji (1-3 lata) redukcja może osiągnąć nawet 80-90%²⁷²⁸.

Wskazania do ablacji RFA obejmują²⁹³⁰:
– Łagodne guzki tarczycy potwierdzone w biopsji
– Guzki powodujące objawy uciskowe lub problemy kosmetyczne
– Guzki nadczynne (toksyczne)
– Pacjenci niekwalifikujący się do leczenia operacyjnego lub odmawiający operacji

Ablacja laserowa

Ablacja laserowa (LTA) wykorzystuje energię laserową do wytworzenia ciepła i zniszczenia tkanki guzka. Podobnie jak RFA, jest to procedura małoinwazyjna wykonywana pod kontrolą USG³¹.

Skuteczność ablacji laserowej w zmniejszaniu guzków tarczycy została potwierdzona w badaniach klinicznych. Guzki mogą zmniejszyć swoją objętość nawet o 70% po 6 miesiącach od zabiegu³².

Ablacja mikrofalowa

Ablacja mikrofalowa (MWA) stanowi kolejną opcję leczenia guzków tarczycy. Wykorzystuje energię mikrofalową do generowania ciepła, które niszczy tkankę guzkową³³³⁴.

Iniekcje etanolowe

Przezskórna iniekcja etanolu (PEI) jest metodą stosowaną głównie w leczeniu guzków torbielowatych lub mieszanych z przewagą komponenty płynowej³⁵.

Procedura polega na nakłuciu guzka pod kontrolą USG i aspiracji płynu, a następnie wstrzyknięciu alkoholu etylowego, który powoduje denaturację białek i martwicę komórek wyściełających torbiel³⁶.

Skuteczność PEI w leczeniu guzków torbielowatych jest wysoka, z niskim odsetkiem nawrotów w porównaniu do samej aspiracji płynu (7-38%)³⁷.

Embolizacja tętnic tarczowych

Embolizacja tętnic tarczowych (TAE) jest metodą polegającą na zamknięciu naczyń krwionośnych zaopatrujących guzki tarczycy. Badania wykazały, że TAE może znacząco zmniejszyć objętość dużych guzków tarczycy w okresie trzech miesięcy po zabiegu³⁸³⁹.

Leczenie guzków złośliwych

Podejście do leczenia guzków złośliwych (raka tarczycy) różni się od postępowania z guzkami łagodnymi⁴⁰.

Opcje chirurgiczne

Leczeniem z wyboru w przypadku guzków złośliwych jest zabieg chirurgiczny⁴¹:
– Lobektomia – w przypadku bardzo małych, dobrze zróżnicowanych raków
– Całkowita tyroidektomia – w przypadku większości raków tarczycy
– Wycięcie układu chłonnego szyi – gdy rak przerzutuje do węzłów chłonnych

Po całkowitym usunięciu tarczycy pacjent wymaga dożywotniej terapii zastępczej hormonami tarczycy (lewotyroksyną)⁴².

Leczenie uzupełniające

Po operacji mogą być stosowane dodatkowe metody leczenia⁴³⁴⁴:
– Terapia radiojodem (I-131) – w celu zniszczenia pozostałych komórek raka i zmniejszenia ryzyka nawrotu (głównie w rakach zróżnicowanych)
– Terapia hormonalna – w celu supresji TSH i zahamowania wzrostu ewentualnych pozostałych komórek nowotworowych
– Terapia celowana – w przypadku zaawansowanych lub nawrotowych raków (lenvatinib, sorafenib, cabozantinib)
– Chemioterapia – rzadko stosowana, głównie w rakach anaplastycznych

Aktywna obserwacja

W przypadku bardzo małych raków brodawkowatych (mikroraki o średnicy poniżej 1 cm), które charakteryzują się niskim ryzykiem wzrostu i rozsiewu, alternatywą dla leczenia operacyjnego może być aktywna obserwacja. Polega ona na regularnym monitorowaniu guza bez podejmowania natychmiastowego leczenia⁴⁵⁴⁶.

Leczenie guzków specjalnego typu

Guzki nadczynne („gorące”)

Guzki nadczynne (autonomiczne) produkują hormony tarczycy niezależnie od regulacji przez przysadkę mózgową. Są prawie zawsze łagodne, ale mogą prowadzić do nadczynności tarczycy (hipertyreoza)⁴⁷.

Opcje leczenia guzków nadczynnych obejmują⁴⁸⁴⁹:
– Terapię radiojodem (I-131) – metoda preferowana, prowadzi do zmniejszenia guzka i normalizacji funkcji tarczycy
– Leczenie chirurgiczne – usunięcie części lub całej tarczycy
– Leki przeciwtarczycowe (metimazol) – opcja dla pacjentów, którzy nie mogą być leczeni radiojodem lub operacyjnie
– Ablacja RFA – coraz częściej stosowana alternatywa dla innych metod leczenia

Decyzja o metodzie leczenia zależy od wieku pacjenta, wielkości guzka, nasilenia objawów i preferencji pacjenta⁵⁰.

Guzki torbielowate

Guzki torbielowate tarczycy to najczęściej łagodne zmiany wypełnione płynem. Mogą one ulegać samoistnej resorpcji po aspiracji płynu⁵¹.

Metody leczenia guzków torbielowatych obejmują⁵²⁵³:
– Aspirację płynu pod kontrolą USG
– Iniekcję etanolu (skleroterapię) – szczególnie w przypadku nawracających torbieli
– Usunięcie chirurgiczne – gdy torbiel nawraca mimo innych metod leczenia

Guzki o niejednoznacznym rozpoznaniu

Guzki o niejednoznacznym rozpoznaniu cytopatologicznym stanowią wyzwanie diagnostyczne. Zgodnie z klasyfikacją Bethesda, wyróżnia się kategorie o różnym ryzyku złośliwości⁵⁴⁵⁵:

1. Guzki z podejrzeniem nowotworu pęcherzykowego (Bethesda IV) – ryzyko złośliwości 23-34%:
– Możliwe wykonanie badań molekularnych
– Często wymagana lobektomia diagnostyczna

2. Guzki z atypią o nieokreślonym znaczeniu (Bethesda III) – ryzyko złośliwości 13-30%:
– Powtórzenie biopsji
– Badania molekularne
– Obserwacja lub operacja w zależności od wyników

3. Guzki podejrzane o złośliwość (Bethesda V) – ryzyko złośliwości 67-83%:
– Zwykle zalecana operacja (lobektomia lub całkowita tyroidektomia)

W ostatnich latach coraz większą rolę w diagnostyce guzków o niejednoznacznym rozpoznaniu odgrywają badania molekularne, które pomagają w stratyfikacji ryzyka i podejmowaniu decyzji terapeutycznych⁵⁶.

Nowe trendy w leczeniu guzków tarczycy

W ostatnich latach obserwuje się rozwój nowych metod leczenia guzków tarczycy oraz rozszerzenie wskazań do metod małoinwazyjnych⁵⁷⁵⁸:

1. Ablacja RFA w leczeniu małych raków brodawkowatych (mikroraków):
– Badania kliniczne oceniające bezpieczeństwo i skuteczność RFA jako alternatywy dla chirurgii w wybranych przypadkach małych raków tarczycy (poniżej 1,5 cm)

2. Ablacja RFA w leczeniu guzków o niejednoznacznym rozpoznaniu:
– Badania nad zastosowaniem RFA w leczeniu guzków z wynikiem Bethesda III/IV, które w badaniach molekularnych wykazują niskie ryzyko złośliwości

3. Połączenie różnych technik ablacyjnych:
– Łączenie różnych metod (np. RFA i PEI) w celu zwiększenia skuteczności leczenia

4. Zogniskowany ultradźwięk o wysokiej intensywności (HIFU):
– Nieinwazyjna metoda ablacji guzków tarczycy z użyciem ultradźwięków

Podsumowanie wskazań do leczenia guzków tarczycy

Typ guzka	Metody leczenia	Uwagi
Łagodny, bezobjawowy	Obserwacja (badanie fizykalne, USG co 6-12 miesięcy)	Najczęstsza strategia postępowania
Łagodny, duży, powodujący objawy uciskowe	– Ablacja RFA – Leczenie chirurgiczne (lobektomia/tyroidektomia)	RFA coraz częściej wybierana jako alternatywa dla chirurgii
Guzek nadczynny („gorący”)	– Terapia radiojodem – Leki przeciwtarczycowe – Ablacja RFA – Leczenie chirurgiczne	Wybór zależy od wieku pacjenta, wielkości guzka i preferencji
Guzek torbielowaty	– Aspiracja płynu – Iniekcja etanolu (PEI) – Leczenie chirurgiczne przy nawrotach	PEI jest metodą z wyboru w przypadku nawracających torbieli
Guzek o niejednoznacznym rozpoznaniu	– Badania molekularne – Leczenie chirurgiczne – Obserwacja przy niskim ryzyku	Strategia zależy od kategorii Bethesda i wyniku badań molekularnych
Guzek złośliwy	– Leczenie chirurgiczne – Terapia radiojodem (uzupełniająco) – Terapia supresyjna L-tyroksyną – Terapia celowana w zaawansowanych przypadkach	Zakres operacji zależy od stopnia zaawansowania raka
Mikroraki brodawkowate (<1 cm)	– Aktywna obserwacja – Leczenie chirurgiczne – Ablacja RFA (w ramach badań klinicznych)	Rosnąca akceptacja aktywnej obserwacji w wybranych przypadkach

Wybór metody leczenia guzków tarczycy powinien być zindywidualizowany i uwzględniać charakterystykę guzka, preferencje pacjenta oraz doświadczenie ośrodka w stosowaniu poszczególnych technik terapeutycznych⁵⁹⁶⁰.

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Materiały źródłowe

#1 Approach to Thyroid Nodules: Diagnosis and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC10861804/
Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. […] The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. […] Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. […] The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. […] The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. […] Patients with benign TNs typically do not require surgery. […] The treatment approach for TNs with indeterminate cytology varies based on institutional expertise. […] It is usually considered fitting to opt for surgery when TNs appear suspicious of malignancy.
#2 Thyroid Nodules | American Thyroid Association
https://www.thyroid.org/thyroid-nodules/
HOW ARE THYROID NODULES TREATED? […] All thyroid nodules that are found to contain a thyroid cancer, or that are highly suspicious of containing a cancer, should be removed surgically by an experienced thyroid surgeon. […] Thyroid nodules that are benign by FNA or too small to biopsy should still be watched closely with ultrasound examination every 6 to 12 months and annual physical examination by your doctor. […] Surgery may still be recommended even for a nodule that is benign by FNA if it continues to grow, or develops worrisome features on ultrasound over the course of follow up.
#3 Thyroid nodules – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/diagnosis-treatment/drc-20355266
Treatment depends on the type of thyroid nodule you have. […] If a thyroid nodule isn’t cancerous, treatment options include: […] Watchful waiting. If a biopsy shows that you have a noncancerous thyroid nodule, your doctor may suggest simply watching your condition. […] Thyroid hormone therapy. If your thyroid function test finds your gland isn’t producing enough thyroid hormone, your doctor may recommend thyroid hormone therapy. […] Surgery. A noncancerous nodule may sometimes require surgery if it’s so large that it makes it hard to breathe or swallow. […] If a thyroid nodule is producing thyroid hormones, overloading your thyroid gland’s normal hormone production levels, your doctor may recommend treating you for hyperthyroidism. This may include: […] Radioactive iodine. Doctors use radioactive iodine to treat hyperthyroidism.
#4 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
The appropriate thyroid nodule treatment depends upon the type of thyroid nodule that is found. […] Benign thyroid nodules usually develop as a result of overgrowth of normal thyroid tissue. Surgery is not usually recommended, and a benign nodule can be monitored with ultrasound over time. If it grows, a repeat biopsy or surgery may be recommended. Some surgeons recommend excision (removal) of nodules over 4 cm. […] Large benign thyroid nodules may also be treated with radiofrequency ablation. With this technique, a needle-like probe is inserted in the nodule using ultrasound guidance. The probe uses thermal energy (heat) to destroy most of the nodule and reduce its size. […] If a thyroid nodule is not cancerous, but it is large, some health care providers will suggest a trial of thyroid hormone (thyroxine [T4]) to shrink the nodule; this is called suppressive treatment. The American Thyroid Association guidelines do not recommend this treatment, because only a small percentage of nodules shrink and suppressive therapy may have side effects (eg, abnormal heart rhythm or loss of calcium from bone). Thyroid hormone levels should be monitored carefully during suppressive treatment.
#5 Thyroid Nodules: Causes, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/13121-thyroid-nodule
Treatment depends on the type of thyroid nodule. Treatment options include: […] Surgery to take out the nodules is the best treatment for nodules that are cancerous, cause obstructive symptoms like breathing or swallowing issues and are suspicious (they cant be diagnosed without being surgically removed and examined). […] Your provider may use radioactive iodine to treat hyperfunctioning thyroid nodules and goiters with several nodules. Your thyroid gland absorbs the radioactive iodine, causing the nodules to shrink. […] If the nodules arent cancerous, you and your healthcare provider may decide that you dont need to be treated at this time. Youll see your provider regularly so they can check for any changes in the nodules.
#6 Thyroid Nodules | American Thyroid Association
https://www.thyroid.org/thyroid-nodules/
HOW ARE THYROID NODULES TREATED? […] All thyroid nodules that are found to contain a thyroid cancer, or that are highly suspicious of containing a cancer, should be removed surgically by an experienced thyroid surgeon. […] Thyroid nodules that are benign by FNA or too small to biopsy should still be watched closely with ultrasound examination every 6 to 12 months and annual physical examination by your doctor. […] Surgery may still be recommended even for a nodule that is benign by FNA if it continues to grow, or develops worrisome features on ultrasound over the course of follow up.
#7 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
The appropriate thyroid nodule treatment depends upon the type of thyroid nodule that is found. […] Benign thyroid nodules usually develop as a result of overgrowth of normal thyroid tissue. Surgery is not usually recommended, and a benign nodule can be monitored with ultrasound over time. If it grows, a repeat biopsy or surgery may be recommended. Some surgeons recommend excision (removal) of nodules over 4 cm. […] Large benign thyroid nodules may also be treated with radiofrequency ablation. With this technique, a needle-like probe is inserted in the nodule using ultrasound guidance. The probe uses thermal energy (heat) to destroy most of the nodule and reduce its size. […] If a thyroid nodule is not cancerous, but it is large, some health care providers will suggest a trial of thyroid hormone (thyroxine [T4]) to shrink the nodule; this is called suppressive treatment. The American Thyroid Association guidelines do not recommend this treatment, because only a small percentage of nodules shrink and suppressive therapy may have side effects (eg, abnormal heart rhythm or loss of calcium from bone). Thyroid hormone levels should be monitored carefully during suppressive treatment.
#8 Thyroid Nodules: Advances in Evaluation and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2020/0901/p298.html
New advances in molecular testing have changed the management of thyroid nodules. […] Over the past few years, molecular testing of fine-needle aspiration specimens has changed the way thyroid nodules with indeterminate cytology are managed. […] The American Thyroid Association recommends that after consideration of clinical and ultrasound features, molecular testing be used to further risk-stratify indeterminate thyroid nodules. […] Radioactive iodine ablation should be considered for hyperfunctioning thyroid nodules. If this procedure cannot be performed because of a contraindication or patient preference, hyperthyroidism should be treated with an antithyroid drug. […] If cytology and/or molecular test results show malignancy (Bethesda category 6) or suspicion for malignancy (Bethesda category 5, or category 3 or 4 with suspicious molecular test results), surgical referral is recommended to remove the affected thyroid lobe or the entire thyroid gland.
#9 Thyroid nodules – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/diagnosis-treatment/drc-20355266
Anti-thyroid medications. In some cases, your doctor may recommend an anti-thyroid medication such as methimazole (Tapazole) to reduce symptoms of hyperthyroidism. […] Surgery. If treatment with radioactive iodine or anti-thyroid medications isn’t an option, you may be a candidate for surgery to remove the overactive thyroid nodule. […] Treatment for a nodule that’s cancerous usually involves surgery. […] Observation. Very small cancers have a low risk of growing, so it may be appropriate for your doctor to closely watch cancerous nodules before treating them. […] Surgery. A common treatment for cancerous nodules is surgical removal. […] After a thyroid surgery, you’ll need lifelong treatment with levothyroxine to supply your body with thyroid hormone. […] Alcohol ablation. Another option for management of certain small cancerous nodules is alcohol ablation.
#10 Medication for Thyroid Nodules & Cancers | NYU Langone Health
https://nyulangone.org/conditions/thyroid-nodules-cancers/treatments/medication-for-thyroid-nodules-cancers
Medication for Thyroid Nodules Cancers […] NYU Langone doctors prescribe a variety of medications to manage certain types of thyroid nodules, including toxic thyroid nodules, toxic multinodular goiters, and thyroid cancers. […] Toxic nodules and multinodular goiters, which cause hyperthyroidism, can often be managed with antithyroid agents before turning to treatments such as radioactive iodine therapy or surgery. […] Antithyroid medications, which include methimazole and propylthiouracil, reduce the amount of hormone produced by the thyroid. They control, but do not cure, hyperthyroidism. […] In addition to antithyroid medications, your doctor may prescribe a class of medications known as beta blockers for toxic nodules and multinodular goiters causing hyperthyroidism. […] If the thyroid gland has been surgically removed or destroyed with radioactive iodine therapy, your doctor may prescribe a thyroid medication called levothyroxine. […] NYU Langone doctors may prescribe chemotherapy, a group of drugs that target cancer cells throughout the body, for people with thyroid cancer that has spread to other parts of the body, such as the liver or lungs. […] NYU Langone doctors may also prescribe targeted drugs to treat thyroid cancer that has spread or returned after treatment. […] Thyroid hormone is well tolerated, although the compounds used to create the pills may rarely cause allergies. Beta blockers can cause fatigue, cold hands, and headache, and antithyroid agents may lead to joint aches, nausea, changes in liver function, and lower levels of white blood cells, which can increase the risk of infection. […] If you are experiencing any side effects, tell your NYU Langone doctor, who can adjust the dose of the drug, prescribe another, and refer you to specialists who provide support services and integrative therapies.
#11 Toxic Thyroid Nodule – Non-Surgical Treatment Specialist
https://cvithyroidcenter.com/toxic-thyroid-nodule-rfa-treatment/
The goal of treatment for TNG is the rapid and long-lasting elimination of the state of hyperthyroidism. The most common treatment options for hyperthyroidism are antithyroid drugs, radioiodine therapy, and surgery. Additionally, minimally invasive procedures, such as radiofrequency ablation (RFA), have also become available. The choice of treatment for TNG will depend on the severity of the hyperthyroidism, coexisting conditions, the presence of contraindications for specific treatment modalities, and the patients preferences. […] In the treatment of toxic nodules, antithyroid drugs can be prescribed to treat hyperthyroidism. Moreover, beta-blockers can also help diminish hyperthyroidism-related symptoms (i.e. increased heart rate), if present. However, these drugs are only useful to temporarily control thyroid hormone production and prevent complications. Given that if this type of treatment is suspended the hyperthyroidism reappears, these medications are more of a bridge to definite therapy as opposed to a final solution for TNG. Additionally, antithyroid drugs can also help control hormone production in preparation for definitive treatments such as surgery or radioactive iodine therapy.
#12 Thyroid nodules – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/diagnosis-treatment/drc-20355266
Treatment depends on the type of thyroid nodule you have. […] If a thyroid nodule isn’t cancerous, treatment options include: […] Watchful waiting. If a biopsy shows that you have a noncancerous thyroid nodule, your doctor may suggest simply watching your condition. […] Thyroid hormone therapy. If your thyroid function test finds your gland isn’t producing enough thyroid hormone, your doctor may recommend thyroid hormone therapy. […] Surgery. A noncancerous nodule may sometimes require surgery if it’s so large that it makes it hard to breathe or swallow. […] If a thyroid nodule is producing thyroid hormones, overloading your thyroid gland’s normal hormone production levels, your doctor may recommend treating you for hyperthyroidism. This may include: […] Radioactive iodine. Doctors use radioactive iodine to treat hyperthyroidism.
#13 Approach to Thyroid Nodules: Diagnosis and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC10861804/
Thyroid nodules (TNs) are prevalent and found in up to 50% of individuals. […] The evaluation of TNs is crucial to rule out malignancy and identify those requiring surgical intervention. […] Fine-needle aspiration (FNA) is crucial in deciding whether surgery or surveillance is necessary. […] The management and treatment approach for TNs primarily depends on the results of FNA cytology and ultrasound characteristics. […] The optimal treatment strategy for TNs ranges from straightforward follow-ups for low-risk cases to surgical intervention for high-risk patients. […] Patients with benign TNs typically do not require surgery. […] The treatment approach for TNs with indeterminate cytology varies based on institutional expertise. […] It is usually considered fitting to opt for surgery when TNs appear suspicious of malignancy.
#14 Thyroid cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/diagnosis-treatment/drc-20354167
Your thyroid cancer treatment options depend on the type and stage of your thyroid cancer, your overall health, and your preferences. […] Most people diagnosed with thyroid cancer have an excellent prognosis, as most thyroid cancers can be cured with treatment. […] Treatment might not be needed right away for very small papillary thyroid cancers (papillary microcarcinomas) because these cancers have a low risk of growing or spreading. As an alternative to surgery or other treatments, you might consider active surveillance with frequent monitoring of the cancer. […] Most people with thyroid cancer that requires treatment will undergo surgery to remove part or all of the thyroid. […] Operations used to treat thyroid cancer include: Removing all or most of the thyroid (thyroidectomy). An operation to remove the thyroid gland might involve removing all of the thyroid tissue (total thyroidectomy) or most of the thyroid tissue (near-total thyroidectomy).
#15 Thyroid cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/diagnosis-treatment/drc-20354167
Removing a portion of the thyroid (thyroid lobectomy). During a thyroid lobectomy, the surgeon removes half of the thyroid. […] Thyroid hormone therapy is a treatment to replace or supplement the hormones produced in the thyroid. […] Radioactive iodine treatment uses a form of iodine that’s radioactive to kill thyroid cells and thyroid cancer cells that might remain after surgery. […] Alcohol ablation, which is also called ethanol ablation, involves using a needle to inject alcohol into small areas of thyroid cancer. […] Aggressive thyroid cancers that grow more quickly may require additional treatment options to control the disease. Options might include: Targeted drug therapy. […] Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. […] After your thyroid cancer treatment ends, your provider may recommend follow-up tests and procedures to look for signs that your cancer has returned.
#16 Thyroid nodules – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-nodules/diagnosis-treatment/drc-20355266
Anti-thyroid medications. In some cases, your doctor may recommend an anti-thyroid medication such as methimazole (Tapazole) to reduce symptoms of hyperthyroidism. […] Surgery. If treatment with radioactive iodine or anti-thyroid medications isn’t an option, you may be a candidate for surgery to remove the overactive thyroid nodule. […] Treatment for a nodule that’s cancerous usually involves surgery. […] Observation. Very small cancers have a low risk of growing, so it may be appropriate for your doctor to closely watch cancerous nodules before treating them. […] Surgery. A common treatment for cancerous nodules is surgical removal. […] After a thyroid surgery, you’ll need lifelong treatment with levothyroxine to supply your body with thyroid hormone. […] Alcohol ablation. Another option for management of certain small cancerous nodules is alcohol ablation.
#17
https://www.singhealth.com.sg/patient-care/conditions-treatments/thyroid-nodules
Your surgeon will explain which operation you require and the reason for it. […] Other than the risks that apply to all surgery, including general anaesthesia risk, risk of bleeding and infection, the risks specific to thyroidectomy are: Hoarseness, Difficulty breathing, Low calcium, Need to take thyroid hormone replacement medication. […] In suitable patients, thyroid surgery can be performed without using a neck incision. The surgery may be endoscopic or robot-assisted, with skin incisions located in the axilla or armpit and less visible than a neck scar. […] Some thyroid cancers can spread to the lymph nodes in the neck, and your doctor may need to remove some of the lymph nodes in your neck during the operation as well.
#18 Radioactive Iodine Therapy for Thyroid Nodules & Cancers | NYU Langone Health
https://nyulangone.org/conditions/thyroid-nodules-cancers/treatments/radioactive-iodine-therapy-for-thyroid-nodules-cancers
Radioactive iodine therapy for thyroid nodules cancers. […] NYU Langone doctors may prescribe radioactive iodine therapy to manage some toxic, or overactive, nodules and some types of thyroid cancers. […] The therapy is especially beneficial for people with toxic nodules that do not respond to other medications or who need medication throughout their lifetime. Radioactive iodine therapy may also help shrink a large toxic multinodular goiter. […] Radioactive iodine may also be helpful for people with certain types of thyroid cancer. Papillary and follicular thyroid cancers develop from follicular cells, which absorb iodine. When you are given radioactive iodine, it is taken up by cancer cells and destroys them including those that have spread to the lymph nodes or other parts of the body.
#19 Toxic Thyroid Nodule – Non-Surgical Treatment Specialist
https://cvithyroidcenter.com/toxic-thyroid-nodule-rfa-treatment/
Radioiodine therapy is widely used as a definitive treatment for toxic adenoma and toxic multinodular goiter. In fact, it is the most widely used treatment for toxic nodules in the United States. This therapy is based on the fact that the thyroid gland takes up almost all the iodine in the body. Thus, when radioactive iodine (I-131) is administered it can accumulate in the overactive gland tissue and destroy it. As a result, toxic nodules can decrease in size and the signs and symptoms of hyperthyroidism can subside (usually within 2-3 months). […] Thyroid surgery is one of the definitive treatments for toxic nodules. A thyroidectomy, or the surgical removal of all or part of the gland, might be necessary if other treatments are inappropriate or contraindicated. Possible indications for surgery include signs and symptoms of excessive pressure in the neck by an enlarged thyroid (i.e. difficulty swallowing or breathing), concern for thyroid cancer, failure of radioiodine therapy, and the need for a rapid resolution of the thyrotoxic state (life-threatening condition induced by excessive thyroid hormone secretion).
#20
https://www.nhs.uk/conditions/overactive-thyroid-hyperthyroidism/treatment/
Radioactive iodine treatment is a type of radiotherapy used to destroy the cells in the thyroid gland, reducing the amount of hormones it can produce. It’s a highly effective treatment that can cure an overactive thyroid. […] You’re given a drink or capsule that contains iodine and a low dose of radiation, which is absorbed by your thyroid. Most people only need a single treatment. […] Occasionally, surgery to remove all or part of your thyroid may be recommended. […] Removing all of the thyroid gland is usually recommended because it stops the symptoms of hyperthyroidism coming back. […] But removing your thyroid means your body will be unable to produce thyroid hormones so you’ll need to take medicine, such as levothyroxine, for the rest of your life.
#21 Radioactive Iodine Therapy for Thyroid Nodules & Cancers | NYU Langone Health
https://nyulangone.org/conditions/thyroid-nodules-cancers/treatments/radioactive-iodine-therapy-for-thyroid-nodules-cancers
Risks include damage to the salivary glands, which may cause dry mouth and make swallowing difficult. It can also damage the tear ducts, causing dry eye. These side effects can be temporary or permanent. […] When doctors use radioactive iodine therapy, they carefully manage the dose to make sure it targets the toxic nodule or cancer, minimizing the risk of side effects. […] Radioactive iodine therapy for thyroid cancer is most effective in people who have high levels of thyroid-stimulating hormone, or TSH. […] Your doctor can increase your TSH levels by using recombinant human thyroid hormone (rhTSH), which is a thyroid-stimulating hormone made in a laboratory. […] Before radioactive iodine treatments, doctors typically ask you to go on a low-iodine diet. This depletes the body’s levels of inorganic iodine, a mineral the thyroid uses to make thyroid hormone. Low iodine levels cause thyroid tissue and thyroid cancer to better absorb radioactive iodine, making treatment as effective as possible. […] When radioactive iodine therapy is being considered for thyroid cancer, the body must be depleted of inorganic iodine, so the levels of thyroid-stimulating hormone increase, helping with the effectiveness of radioactive iodine therapy.
#22 Radioactive Iodine Therapy for Thyroid Nodules & Cancers | NYU Langone Health
https://nyulangone.org/conditions/thyroid-nodules-cancers/treatments/radioactive-iodine-therapy-for-thyroid-nodules-cancers
If you’ve had surgery for papillary or follicular thyroid cancer, your doctor may prescribe radioactive iodine afterward. It may help prevent the cancer from returning. […] Radioactive iodine therapy is usually not effective for medullary and anaplastic thyroid cancers, because they do not absorb iodine. […] Whether you’ve been treated for a toxic nodule or thyroid cancer, you may need to take the thyroid hormone medication levothyroxine daily as part of your long-term care because radioactive iodine therapy destroys healthy thyroid tissue. […] NYU Langone doctors do not prescribe this therapy for everyone with papillary and follicular thyroid cancer. Those with small or less aggressive thyroid cancers may not benefit from treatment with radioactive iodine. Instead, a doctor may prescribe it for people whose cancer has spread or those who are at risk of a recurrence.
#23 Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies
https://pmc.ncbi.nlm.nih.gov/articles/PMC9016471/
Thermal ablation, particularly RFA, is becoming an attractive option for managing a subgroup of solid thyroid nodules, while PEI has a role in managing thyroid cysts and a select group of PTMC. Their role in the algorithm of thyroid nodule management is still being refined and technical expertise will be essential to reproduce the reported results into everyday practice. […] Several ablative therapies have thus evolved over the last few years aimed at treating these nodules while avoiding described risks. […] Nodular focal ablative therapies have surfaced over the last couple decades. Chemical ablation of thyroid lesions with ethanol is the first such approach to have withstood the clinical efficacy test. Its principle is that of exposing the targeted cells directly to highly concentrated alcohol and thus affecting their viability. Thermal ablation (TA) of thyroid nodules is a more recent addition to this field. It has many technological facets (radiofrequency ablation [RFA], laser thermal ablation [LTA], microwave ablation [MWA], and high-intensity frequency ultrasound [HIFU]) that are involved in delivering the energy to the target lesion and destroying its constitutive cells.
#24 Thyroid Nodule Clinic | OHSU
https://www.ohsu.edu/dotter-interventional-institute/thyroid-nodule-clinic
The Dotter Department of Interventional Radiology, in conjunction with the Thyroid and Parathyroid clinic at OHSU, is now offering radiofrequency ablation of symptomatic benign thyroid nodules. This minimally invasive outpatient procedure is a thyroid preserving alternative to surgery or radioiodine therapy. […] Thyroid nodule ablation is used to treat benign nodules that cause compression on the airway, cause difficulty swallowing, or are disfiguring. Additionally, nodules that produce thyroid hormone (autonomously functioning nodules) and cause symptoms can be treated with ablation. […] This minimally invasive outpatient procedure can effectively treat symptomatic thyroid nodules without the need for surgery. The procedure preserves normal thyroid tissue and function. […] Thyroid nodule ablation is performed in the outpatient setting and does not require an overnight stay in the hospital. After having the neck cleaned and sterilely draped, the skin and neck around the thyroid gland are numbed with lidocaine. Local anesthetic with lidocaine is adequate for the majority of patients, although moderate sedation can be given if needed. Once the area is numb, the radiofrequency probe (like a needle) is inserted into the nodule from a trans-isthmic approach. Under ultrasound guidance, the nodule is heated to kill the tissue using the moving shot technique. For most patients one or even several nodules can be treated from a single skin puncture. Typically the procedure lasts between 1-2 hours depending on the size and number of nodules treated. At the end of the procedure, the probe is removed and a Band-Aid is applied. Patients are observed for 1 hour, discharged to home and can resume normal activities the next day.
#25 Treatment Options for Thyroid Nodules – RFA For Life
https://rfaforlife.com/thyroidrfa-blogs/treatment-options-for-your-thyroid-nodules/
#26 WashU offers safe and effective, nonsurgical treatment option for benign thyroid nodules | Division of Endocrinology, Metabolism & Lipid Research | Washington University in St. Louis
https://endocrinology.wustl.edu/washu-now-offers-safe-and-effective-nonsurgical-treatment-option-for-benign-thyroid-nodules/
Patients navigating symptomatic or growing benign thyroid nodules can now receive safe and effective, nonsurgical treatments using radiofrequency ablation (RFA) technology or percutaneous ethanol injection (PEI), provided by Washington Universitys Division of Endocrinology, Metabolism and Lipid Research. […] Approved by the U.S. Food and Drug Administration, RFA technology is widely supported by robust evidence of efficacy and tolerability. […] The technique serves as a nonsurgical treatment option that involves the use of heat to shrink the nodules, resulting in thermal tissue necrosis and fibrosis. […] Aside from being safe and effective, minimally invasive techniques offer many additional benefits, such as patients get to avoid surgery and general anesthesia, the need for thyroid hormone replacement is eliminated, the risk of scarring is greatly reduced, and the procedure preserves normal thyroid function while shrinking benign thyroid nodules.
#27 Radiofrequency ablation therapy for large benign thyroid nodules – Mayo Clinic
https://www.mayoclinic.org/medical-professionals/endocrinology/news/radiofrequency-ablation-therapy-for-large-benign-thyroid-nodules/mac-20439239
Thyroid nodules before and after RFA […] Most thyroid nodules are benign and do not need intervention. However, some thyroid nodules are associated with progressive growth and may result in compressive symptoms and cosmetic concerns that might require intervention typically thyroid surgery. Radiofrequency ablation (RFA) is a percutaneous treatment that results in thermal tissue necrosis and fibrosis. As a result of this process, the nodules shrink. Clinical trials in Italy and South Korea demonstrated a 50 to 80 percent durable nodule shrinkage after thyroid nodule RFA. […] RFA for the management of benign thyroid nodules was first used at Mayo Clinic’s Rochester campus in December 2013. RFA has been offered to patients with large ( 3 cm), predominantly solid thyroid nodules that demonstrated growth or were causing compressive symptoms and cosmetic concerns.
#28 Thyroid Nodule Clinic | OHSU
https://www.ohsu.edu/dotter-interventional-institute/thyroid-nodule-clinic
Nodule volume reduction on average at 1 month is 60%, at 3 months 75%, at 6 months 85%, and at 3 years 90%. […] You will follow up in clinic after your procedure at 1, 3, 6, and 12 months, where you will have you will have labs drawn and ultrasounds performed. […] If you are interested in learning more about whether this treatment is right for you, contact either the Dotter Department of Interventional Radiology to schedule an appointment with Dr. Park, Dr. Lim, or contact the Thyroid and Parathyroid clinic to schedule an appointment. After your consultation, your case will be presented at a multidisciplinary conference where specialists from Interventional Radiology, Head and Neck surgery, Otolaryngology, Surgical Oncology, and Endocrinology will discuss treatment options.
#29 Radiofrequency Ablation (RFA) for Thyroid Nodules | UW Medicine
https://www.uwmedicine.org/specialties/diabetes-endocrinology/radiofrequency-ablation
Radiofrequency ablation, or RFA, is a minimally invasive technique that shrinks the size of tumors, nodules or other growths in the body. Radiofrequency ablation for the treatment of thyroid nodules is a procedure performed by a team of endocrinologists. RFA uses radio waves to create heat that reduces the size of thyroid nodules. It is a less invasive alternative to surgery or radioactive iodine therapy (RAI). RFA is a safe way to treat patients with symptomatic thyroid nodules. […] RFA protects other parts of the thyroid more than surgery or RAI. This means RFA lowers risk of developing a permanent condition called primary hypothyroidism (low thyroid hormone). Recovery is much faster than surgery, and you can also avoid surgical scars. […] RFA is used to treat: Solid (or mostly solid) thyroid nodules that are proven to be benign by biopsy. Thyroid nodules that cause pressure or cosmetic problems. Over-functioning thyroid nodules.
#30 WashU offers safe and effective, nonsurgical treatment option for benign thyroid nodules | Division of Endocrinology, Metabolism & Lipid Research | Washington University in St. Louis
https://endocrinology.wustl.edu/washu-now-offers-safe-and-effective-nonsurgical-treatment-option-for-benign-thyroid-nodules/
Percutaneous ethanol injection, thermal ablation, and radiofrequency ablation have been successfully used to treat benign thyroid nodules. […] Patients who qualify for RFA treatment must have a benign thyroid nodule that is large or growing, causing compressive symptoms and cosmetic concerns. Prior to receiving RFA, benign nodules must be confirmed by an ultrasound-guided fine-needle aspiration biopsy. This nonsurgical treatment option may also be a viable option for those who cannot receive surgical treatment.
#31 Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies
https://pmc.ncbi.nlm.nih.gov/articles/PMC9016471/
The standard approach would be to treat such a patient with a lobectomy or with RAI therapy in the case of toxic nodules. However, sufficient data indicate that for these cases consideration can also be given to the newly emerging minimally invasive TA modalities. […] Image-guided TA techniques, the most used being RFA and LTA, have been utilized successfully in Europe and Asia for more than a decade. Most studies have focused on RFA; compared with surgery, RFA is associated with fewer complications and side effects, eliminates the need for hospitalization, and results in higher patient satisfaction. RFA has also demonstrated good efficacy in reducing nodule volumeâthe available clinical trials indicate a decrease in volume of 70% to 80% which typically occurs in 6 to 12 months and often persists up to 5 years.
#32 Laser ablation therapy is effective for shrinking benign thyroid nodules but has significant complications
https://www.thyroid.org/patient-thyroid-information/ct-for-patients/january-2016/vol-issue-10-11/
Thyroid nodules Laser ablation therapy is effective for shrinking benign thyroid nodules but has significant complications. […] According to this study, laser ablation therapy of benign nodules is effective, reproducible, and generally well tolerated and has a low risk of major complications. […] This is an interesting technique that is not widely used in the United States. It is important that the centers reporting their data all had at least 2 years of experience with the procedure, which probably contributed to the low number of complications reported. The major complication was temporary vocal-cord paralysis in almost 1% of patients. Also 1 in 3 patients experienced pain with the procedure. Depending on the cost associated with the technique and whether it is easy for physicians to perform, this could potentially become a more common treatment option for benign thyroid nodules.
#33 Thyroid Nodule Treatment Without Surgery – Maven Medical Center
https://www.mavenmedicalcenter.com/thyroid-nodules-treatment
The thyroid is a butterfly-fashioned gland found in each men and women that sits inside the front of the neck. […] Most thyroid nodules are benign, however a few benign nodules can also require treatment for cosmetic reasons, subjective symptoms or malignant adjustments. […] Both surgical and Non-surgical procedures are Available to Treat Thyroid Nodules. […] Although surgical procedure is healing, it may purpose some troubles along with lengthy hospitalization, higher airway obstruction, non-esthetic scars, recurrent laryngeal nerve palsy, iatrogenic hypothyroidism and difficulty in re operation. […] Microwave ablation (MWA) is a minimally invasive methods use to treat benign and malignant tumors of the liver, lung and kidney. […] Nonsurgical and minimally invasive treatments use to treat benign thyroid nodules, of which microwave ablation (MWA) is newly developed.
#34 Treatment Options for Thyroid Nodules – RFA For Life
https://rfaforlife.com/thyroidrfa-blogs/treatment-options-for-your-thyroid-nodules/
Radio Frequency Ablation (RFA) is a treatment option that uses thermal energy created by radiofrequency to ablate (burn) the nodules, reducing the size and volume of the benign lesion. […] Microwave and laser ablation treat thyroid nodules using thermal energy generated by microwave and laser energy, respectively.
#35 Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies
https://pmc.ncbi.nlm.nih.gov/articles/PMC9016471/
The first studies documenting the safety and efficacy of PEI for treating recurring and symptomatic cystic nodules came from Japan, followed shortly thereafter by various reports from Italy. […] Percutaneous ethanol injection (PEI) has been accepted as an effective treatment option for recurring thyroid cysts. […] The risk of recurrence is quite low, compared with cyst drainage alone, and has been reported to range between 7% and 38%. […] TA has been employed for the therapy of PTMC for more than a decade and a few studies are now available to summarize the data. […] The rate of major complication related to TA is low at 0.7% and all were related to voice changes. The overall complication rate was 3.2% and included small hematomas, skin burn (mild), and temporary pain. […] The major contraindications include presence of extrathyroidal extension, presence of cervical adenopathy, genetic basis for thyroid malignancy, and limited visualization by ultrasound.
#36 Thyroid Nodules | Ohio State Medical Center
https://wexnermedical.osu.edu/diabetes-endocrinology/thyroid-gland/thyroid-nodules
Surgery If the thyroid nodule is so large that its causing problems with swallowing or breathing, surgery to remove it might be recommended. This is also a standard course of treatment for nodules that are suspected or known to be cancer. […] Medications If your thyroid isnt functioning properly or producing the right amount of hormone, you may be prescribed thyroid medications to either increase the amount of thyroid hormone (if hypothyroid) or medications to decrease thyroid hormone (if hyperthyroid). […] Thyroid radiofrequency ablation A new, minimally invasive procedure, this allows us to shrink or eradicate nodules by using a needle that heats and destroys the thyroid nodule tissue. […] Ethanol ablation If a nodule is filled with fluid (a cyst), we can do this procedure, which involves removing the fluid and then injecting ethanol into the cyst to ensure it shrinks.
#37 Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies
https://pmc.ncbi.nlm.nih.gov/articles/PMC9016471/
The first studies documenting the safety and efficacy of PEI for treating recurring and symptomatic cystic nodules came from Japan, followed shortly thereafter by various reports from Italy. […] Percutaneous ethanol injection (PEI) has been accepted as an effective treatment option for recurring thyroid cysts. […] The risk of recurrence is quite low, compared with cyst drainage alone, and has been reported to range between 7% and 38%. […] TA has been employed for the therapy of PTMC for more than a decade and a few studies are now available to summarize the data. […] The rate of major complication related to TA is low at 0.7% and all were related to voice changes. The overall complication rate was 3.2% and included small hematomas, skin burn (mild), and temporary pain. […] The major contraindications include presence of extrathyroidal extension, presence of cervical adenopathy, genetic basis for thyroid malignancy, and limited visualization by ultrasound.
#38 Approach to Thyroid Nodules: Diagnosis and Treatment
https://pmc.ncbi.nlm.nih.gov/articles/PMC10861804/
Several non-surgical methods are available for treating and monitoring TNs. […] Radiofrequency ablation (RFA) and percutaneous ethanol (EtOH) injection are contemporary minimally invasive alternatives for managing local or regional recurrence of well-differentiated thyroid cancer (WTC) instead of surgical intervention. […] Thyroid artery embolization (TAE) can significantly reduce the volumes of sizable thyroid nodules in a three-month follow-up.
#39 THYROID NODULES
https://www.thyroid-goiter.com/thyroid-nodules
Alcohol ablation is considered the first line treatment in cystic nodules, although it can also be used in solid nodules in selected cases. […] Because of these advantages, percutaneous ablation should be the first line treatment in thyroid nodules. Surgery is reserved only if the nodule(s) are not suitable for or have not benefited from percutaneous ablation. […] In embolization, the feeding vessels of the nodule(s) are occluded with a simple angiography procedure. […] If the result of the first FNAB is inconclusive or suspicious for malignancy, a combined FNAB + trucut biopsy be performed, and surgery be reserved for only those cases in whom the combined biopsy is still indeterminate or reveals cancer.
#40 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
Malignant thyroid nodules (thyroid cancer) â Only approximately 5 percent of all thyroid nodules are malignant. Most people with thyroid cancer have an excellent chance of cure or long-term survival. […] The exact treatment approach will depend on the type and size of cancer. Thyroid cancers require surgical removal of all or part of the thyroid gland and sometimes one or more treatments with radioiodine, followed by thyroid hormone (T4). The goal of taking thyroid hormone is to keep your thyroid-stimulating hormone (TSH) in the lower portion of the normal range or even slightly below normal. If your entire thyroid is removed with surgery, you will need to take daily thyroid hormone for life. […] Suspicious for malignancy â Nodules in this category have a 67 to 83 percent risk of malignancy. People with nodules that are suspicious for malignancy frequently have a lobectomy (surgery to remove part of the thyroid) or a total thyroidectomy (removal of the entire thyroid) because the chance that the nodule is a cancer is higher than the chance it is benign.
#41 Thyroid Nodule Treatment
https://www.thyroidcancer.com/thyroid-nodule/treatment
Almost all thyroid nodules which are malignant are treated by surgery. The options of extent of surgery including total removal of the thyroid gland (total thyroidectomy) versus removal of half of the thyroid gland (thyroid lobectomy) are discussed in detail. Only expert thyroid cancer surgeons should be performing thyroid surgery because the risk to the patients including the nerves to the voice box and glands that control calcium are significantly higher in those that do not do these types of surgery routinely and frequently.
#42 Thyroid Cancer Treatment – NCI
https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq
Thyroid nodules are common but usually are not cancer. […] When a thyroid nodule is found, an ultrasound of the thyroid and a fine-needle aspiration biopsy are often done to check for signs of cancer. Blood tests to check thyroid hormone levels and for antithyroid antibodies in the blood may also be done to check for other types of thyroid disease. […] Thyroid nodules usually don’t cause symptoms or need treatment. Sometimes the thyroid nodules become large enough that it is hard to swallow or breathe and more tests and treatment are needed. Only a small number of thyroid nodules are diagnosed as cancer. […] Well-differentiated tumors (papillary thyroid cancer and follicular thyroid cancer) can be treated and can usually be cured. […] Surgery is the most common treatment for thyroid cancer. One of the following procedures may be used: Lobectomy: Removal of the lobe in which thyroid cancer is found. Lymph nodes near the cancer may also be removed and checked under a microscope for signs of cancer. Near-total thyroidectomy: Removal of all but a very small part of the thyroid. Lymph nodes near the cancer may also be removed and checked under a microscope for signs of cancer. Total thyroidectomy: Removal of the whole thyroid. Lymph nodes near the cancer may also be removed and checked under a microscope for signs of cancer.
#43 Thyroid Cancer Treatment – NCI
https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq
Radiation therapy may be given after surgery to kill any thyroid cancer cells that were not removed. Follicular and papillary thyroid cancers are sometimes treated with radioactive iodine (RAI) therapy. RAI is taken by mouth and collects in any remaining thyroid tissue, including thyroid cancer cells that have spread to other places in the body. […] Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. […] Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. […] Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. […] Watchful waiting is closely monitoring a patient’s condition without giving any treatment until signs or symptoms appear or change.
#44 Treatment of Thyroid Cancer, by Type and Stage | American Cancer Society
https://www.cancer.org/cancer/types/thyroid-cancer/treating/by-stage.html
Most papillary thyroid cancers are treated with surgery. This is most often a total thyroidectomy (in which the entire thyroid is removed), although some small tumors can be treated with a lobectomy (just removing the side of the thyroid containing the tumor). […] For cancers with a higher risk of coming back (or cancers that are not removed completely with surgery), radioactive iodine (RAI) treatment is often given several weeks after thyroidectomy. The goal is to destroy any remaining thyroid tissue and to try to treat any cancer remaining in the body. […] People who have had a thyroidectomy will need to take daily thyroid hormone therapy (levothyroxine pills). If RAI treatment is planned, the start of hormone therapy may be delayed until the treatment is finished. […] If follicular thyroid cancer comes back (recurs) after the initial treatment is finished, it might be found by blood tests, or by imaging tests such as ultrasound or radioiodine scans. The way this recurrence is treated depends mainly on where the cancer is growing, although other factors can be important as well.
#45 Thyroid cancer – Diagnosis and treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/thyroid-cancer/diagnosis-treatment/drc-20354167
Your thyroid cancer treatment options depend on the type and stage of your thyroid cancer, your overall health, and your preferences. […] Most people diagnosed with thyroid cancer have an excellent prognosis, as most thyroid cancers can be cured with treatment. […] Treatment might not be needed right away for very small papillary thyroid cancers (papillary microcarcinomas) because these cancers have a low risk of growing or spreading. As an alternative to surgery or other treatments, you might consider active surveillance with frequent monitoring of the cancer. […] Most people with thyroid cancer that requires treatment will undergo surgery to remove part or all of the thyroid. […] Operations used to treat thyroid cancer include: Removing all or most of the thyroid (thyroidectomy). An operation to remove the thyroid gland might involve removing all of the thyroid tissue (total thyroidectomy) or most of the thyroid tissue (near-total thyroidectomy).
#46 Thyroid Nodules: Advances in Evaluation and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2020/0901/p298.html
There is growing evidence that low-risk micropapillary thyroid cancers smaller than 1 cm can be followed with observation as an alternative to surgical excision. […] Benign nodules (Bethesda category 2, or category 3 or 4 with benign molecular test results) should be followed with repeat ultrasonography 12 to 24 months after the initial FNA, based on the ultrasound characteristics of the nodules. […] If the nodules have not grown significantly, the interval may be extended to three to five years. […] Nodules showing significant growth on follow-up thyroid ultrasonography should undergo repeat FNA or serial ultrasonography, based on the suspicion for malignancy. […] If molecular testing is not performed, patients with category 4 nodules should be referred for diagnostic lobectomy, whereas those with category 3 nodules can undergo repeat FNA.
#47 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
„Hot” thyroid nodules â Some thyroid nodules produce thyroid hormone, similar to the thyroid gland, but do not respond to the body’s hormonal controls. These nodules are called „hot” or „autonomous” thyroid nodules. They are almost always benign, but they can produce too much thyroid hormone, a condition known as hyperthyroidism. […] If you have an autonomous thyroid nodule and high levels of thyroid hormone, you will probably be advised to have surgery to remove the thyroid nodule, or to undergo radiofrequency ablation or radioiodine treatment to destroy the nodule. Long-term treatment with the antithyroid drug methimazole is also an option, although methimazole cannot be taken during pregnancy. […] If you have an autonomous nodule and normal thyroid function or minimal hyperthyroidism, the appropriate treatment will depend on your age and other health factors: In young adults, autonomous nodules may be monitored over time. In older adults, radiofrequency ablation, radioiodine treatment, or surgery may be recommended because high thyroid hormone levels pose a risk of an abnormal heart rhythm (atrial fibrillation) and bone loss (osteoporosis).
#48 Thyroid Nodules Treatment, Symptoms, Cancerous, When to Worry
https://www.medicinenet.com/thyroid_nodules/article.htm
If a nodule causes hyperthyroidism, it is usually noncancerous. Treatment is aimed at preventing the signs, symptoms, and complications of hyperthyroidism, such as heart failure, osteoporosis, and rapid heart rate. Treatments include destroying the gland using radioactive iodine (131-iodine), blocking the production of thyroid hormone with medications, or conservatively following the patient with mild hyperthyroidism. […] „Subclinical hyperthyroidism” refers to an adult patient with a hyperfunctioning nodule, but TSH is minimally suppressed and the blood levels of thyroid hormones are normal. Treatment is individualized based on age, the presence of other medical conditions, and patient preference.
#49 Thyroid nodules and treatment: Get the facts | Cancer | Prevention | UT Southwestern Medical Center
https://utswmed.org/medblog/thyroid-nodule-treatment/
Most thyroid nodules are benign (non-cancerous) and cause no problems if left untreated. However, approximately 5 to 10 percent of thyroid nodules are cancerous but even then, a patient might not need surgery right away because most thyroid cancers grow slowly. […] The treatment your endocrinologist recommends will depend upon the nodule characteristics: […] If your nodule is so large that it is making it hard to swallow or breath, then surgical removal is an option for you. […] This type of nodule can cause symptoms of hyperthyroidism (overactive thyroid) such as weight loss, fatigue, diarrhea, heart palpitations, and other potentially serious health issues. We can treat hot nodules either with radioactive iodine therapy, which is a single dose of oral medication that destroys the over-active thyroid cells in the nodule, or by surgically removing the side with the nodule.
#50 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
„Hot” thyroid nodules â Some thyroid nodules produce thyroid hormone, similar to the thyroid gland, but do not respond to the body’s hormonal controls. These nodules are called „hot” or „autonomous” thyroid nodules. They are almost always benign, but they can produce too much thyroid hormone, a condition known as hyperthyroidism. […] If you have an autonomous thyroid nodule and high levels of thyroid hormone, you will probably be advised to have surgery to remove the thyroid nodule, or to undergo radiofrequency ablation or radioiodine treatment to destroy the nodule. Long-term treatment with the antithyroid drug methimazole is also an option, although methimazole cannot be taken during pregnancy. […] If you have an autonomous nodule and normal thyroid function or minimal hyperthyroidism, the appropriate treatment will depend on your age and other health factors: In young adults, autonomous nodules may be monitored over time. In older adults, radiofrequency ablation, radioiodine treatment, or surgery may be recommended because high thyroid hormone levels pose a risk of an abnormal heart rhythm (atrial fibrillation) and bone loss (osteoporosis).
#51 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
Cystic thyroid nodules â Cystic thyroid nodules are usually benign nodules that have filled with fluid. These nodules may simply collapse when the fluid is removed. Cystic nodules are usually monitored for changes. If the cyst comes back or if the nodule bleeds more than once, surgery can be performed to remove the thyroid nodule. Sometimes the fluid is removed and the cyst is treated by injecting ethanol, which causes the sides of the cyst to become stuck to each other. This prevents the cyst fluid from building up again.
#52 Thyroid Nodules: Symptoms, Diagnosis, Treatment, and Surgery
https://www.webmd.com/a-to-z-guides/what-are-thyroid-nodules
You may not need any treatment for thyroid nodules, especially if they are small and not causing any symptoms. The type of nodule, and whether it’s cancerous, will help you and your doctor decide on the best approach. […] Common treatments include: […] Draining. Fluid in cysts may be removed by your doctor or a specialist using a fine needle. […] Ablation. Your doctor might use heat or an alcohol injection to break up nodules. […] Surgery. Your doctor or a surgeon might remove nodules if they are large, cause symptoms, or are cancerous or if the cancer has spread. Part or all of your thyroid gland may also be removed if necessary. This is called a thyroidectomy. You may also be given radioactive iodine treatment after your operation to make sure any remaining cancer cells are destroyed. If your thyroid gland is removed, you will need to take medication for the rest of your life.
#53 Thyroid nodules and treatment: Get the facts | Cancer | Prevention | UT Southwestern Medical Center
https://utswmed.org/medblog/thyroid-nodule-treatment/
These nodules usually require surgery that removes your entire thyroid gland. However, if the cancer is very small, sometimes you can get away with just taking out the side with the cancer. […] It is usually fine to leave cysts untreated, especially if they are causing no problems. […] Draining the cyst, which is done by inserting a thin needle and removing the fluid, can relieve these symptoms. However, fluid will often reaccumulate. In these situations, we offer a treatment called percutaneous alcohol ablation in which we drain the cyst and inject it with alcohol. The alcohol prevents the cyst from refilling with fluid. […] If you are diagnosed with a thyroid nodule, dont panic. The majority of thyroid nodules are benign, and most do not require surgery. See an endocrinologist to find the most effective treatment option for you and to get your questions answered.
#54 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
Follicular neoplasm â Nodules in this category have a 23 to 34 percent risk of malignancy. If your biopsy shows follicular neoplasm, your health care provider may do a thyroid scan, especially if your TSH level is in the lower portion of the normal range. If the scan shows a „cold” (non-hormone-producing) nodule or your TSH is not low, your provider may test a biopsy sample for certain molecular markers (if available). This information is used to determine whether the nodule should be observed or removed surgically for closer examination. […] If surgery is necessary, a hemithyroidectomy (surgical removal of half of the thyroid) or a total thyroidectomy (removal of the entire thyroid) may be recommended depending on the results of the molecular testing, the size of the nodule, the presence of nodules on the opposite side, and your preferences. „Hot” thyroid nodules are usually not cancerous, and treatment options are based on the results of thyroid function tests and other factors.
#55 Patient education: Thyroid nodules (Beyond the Basics) – UpToDate
https://www.uptodate.com/contents/thyroid-nodules-beyond-the-basics
Atypia of undetermined significance â Nodules in this category have a 13 to 30 percent risk of malignancy. Molecular markers are frequently used to select low-risk nodules for observation rather than surgery. Many people whose biopsy shows nodules with atypical cells require repeat fine-needle aspiration (FNA). However, in many centers, a sample for molecular testing is obtained with all FNAs. The sample is submitted for analysis if the result is follicular lesion or atypia of undetermined significance. The optimal treatment depends upon individual factors, such as your personal risk for thyroid cancer and your past test results (including biopsy, molecular testing, and ultrasound). […] Nondiagnostic â A nondiagnostic (or insufficient) biopsy does not have enough cells for interpretation. It should not be considered a negative biopsy. If your biopsy came back as nondiagnostic, the FNA should be repeated using ultrasound guidance.
#56 Thyroid Nodules: Advances in Evaluation and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2020/0901/p298.html
New advances in molecular testing have changed the management of thyroid nodules. […] Over the past few years, molecular testing of fine-needle aspiration specimens has changed the way thyroid nodules with indeterminate cytology are managed. […] The American Thyroid Association recommends that after consideration of clinical and ultrasound features, molecular testing be used to further risk-stratify indeterminate thyroid nodules. […] Radioactive iodine ablation should be considered for hyperfunctioning thyroid nodules. If this procedure cannot be performed because of a contraindication or patient preference, hyperthyroidism should be treated with an antithyroid drug. […] If cytology and/or molecular test results show malignancy (Bethesda category 6) or suspicion for malignancy (Bethesda category 5, or category 3 or 4 with suspicious molecular test results), surgical referral is recommended to remove the affected thyroid lobe or the entire thyroid gland.
#57 Interventional Treatment of Thyroid Nodules and Recurrent Cancer – Digestive Care Innovations Hub – Digestive Diseases | NewYork-Presbyterian
https://www.nyp.org/digestive/digestive-care-innovations-hub/non-invasive-minimally-invasive-procedures/interventional-treatment-thyroid-nodules-recurrent-cancer
Interventional Treatment of Thyroid Nodules and Recurrent Cancer […] With surgical treatment of nodules, however, at least 25% of patients need to take thyroid hormones for life. […] 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. […] 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 […] Achievement of 80% to 90% reduction in the size of benign thyroid nodules without the need for future thyroid hormone supplementation
#58 Interventional Treatment of Thyroid Nodules and Recurrent Cancer – Digestive Care Innovations Hub – Digestive Diseases | NewYork-Presbyterian
https://www.nyp.org/digestive/digestive-care-innovations-hub/non-invasive-minimally-invasive-procedures/interventional-treatment-thyroid-nodules-recurrent-cancer
Effective treatment of cancer recurrence in the lymph nodes without the need for repeated surgery, which reduces the overall risks of an intervention. […] Interventional endocrinology has the potential to revolutionize the way doctors treat benign thyroid nodules and thyroid cancer that comes back. […] 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. […] The use of thermal ablation techniques, including RFA, has been proposed to treat small papillary thyroid cancers (less than 1.5 cm in size). […] 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. […] 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.
#59 Nonsurgical Management of Thyroid Nodules: The Role of Ablative Therapies
https://pmc.ncbi.nlm.nih.gov/articles/PMC9016471/
The standard approach would be to treat such a patient with a lobectomy or with RAI therapy in the case of toxic nodules. However, sufficient data indicate that for these cases consideration can also be given to the newly emerging minimally invasive TA modalities. […] Image-guided TA techniques, the most used being RFA and LTA, have been utilized successfully in Europe and Asia for more than a decade. Most studies have focused on RFA; compared with surgery, RFA is associated with fewer complications and side effects, eliminates the need for hospitalization, and results in higher patient satisfaction. RFA has also demonstrated good efficacy in reducing nodule volumeâthe available clinical trials indicate a decrease in volume of 70% to 80% which typically occurs in 6 to 12 months and often persists up to 5 years.
#60 Thyroid Nodule Clinic | OHSU
https://www.ohsu.edu/dotter-interventional-institute/thyroid-nodule-clinic
Nodule volume reduction on average at 1 month is 60%, at 3 months 75%, at 6 months 85%, and at 3 years 90%. […] You will follow up in clinic after your procedure at 1, 3, 6, and 12 months, where you will have you will have labs drawn and ultrasounds performed. […] If you are interested in learning more about whether this treatment is right for you, contact either the Dotter Department of Interventional Radiology to schedule an appointment with Dr. Park, Dr. Lim, or contact the Thyroid and Parathyroid clinic to schedule an appointment. After your consultation, your case will be presented at a multidisciplinary conference where specialists from Interventional Radiology, Head and Neck surgery, Otolaryngology, Surgical Oncology, and Endocrinology will discuss treatment options.