What is INTERVENTIONAL THYROIDOLOGY ? Interventional thyroidology is an emerging field that uses percutaneous (i.e. through the skin), image-guided procedures to treat thyroid diseases. Interventional thyroidology 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 precutaneous ethanol injection (PEI) ablation and ultrasound-guided radiofrequency ablation (RFA) of specific types of indicated specific thyroid diseases.
As we handle many different treatment methods for different thyroid diseases, we shall be able to also suggest, without any conflict of interest, alternative treatment options for you, from conservative, watch-and-wait option, shrinkage to total removal/resection of the lesions. We will assess each patient on a unique case-to-case basis for diagnosis and treatment, hoping for the best outcome in each case. COMMITTED TO YOUR WELL-BEING.
What is PERCUTANEOUS ETHANOL INJECTION (PEI) ABLATION OF THYROID NODULE? Many thyroid gland lumps can be cystic in nature, meaning it is filled with fluid. Under ultrasound guidance, the exact nature of the content can be studied. The cystic content can be suctioned (aspirated) out therefore causing the cyst to be smaller (i.e decompressed) though however this depends largely on the viscosity of the fluid content. If watery enough to be able to be sucked through needle, then decompression can be achieved. Treatment options for symptomatic benign cystic or predominately cystic thyroid nodules include needle aspiration, minimally invasive techniques like percutaneous ethanol (alcohol) injection (PEI) besides surgical resection. A prior biopsy or cytology study is mandatory to prove the benign nature of the nodule. With PEI under ultrasound guidance, the ethanol results in permanent tissue damage with subsequent necrosis, fibrosis and thrombosis of cyst wall blood vessels.
An ideal case for PEI : a cystic thyroid nodule that can be aspirated (cyst content as on the left pic)
What is RADIOFREQUENCY ABLATION OF THYROID NODULE? Introducing a fairly new, US-FDA approved treatment for thyroid nodules Radiofrequency Ablation (RFA). In the past, RFA thermal ablation technique has been successfully used for treatment of cancer nodules in the liver, lung, kidney, and bone Some explanation on thyroid nodules and its implications, role of ultrasound-guided Fine Needle Aspiration Cytology (FNAC)/biopsy, the usages, advantages and disadvantages of RFA of the thyroid nodule procedures. The thyroid gland is an important butterfly-shaped bilateral-lobed organ over the neck that produces hormones that control many bodily functions. However, the thyroid gland commonly has nodules within that can enlarge. The nodules maybe solid or cystic (fluid-filled) or a mixture of both. They are commonly non-cancerous though they can be cancerous on rare occasions. Problems with the nodules: 1. Enlarge and may be obvious on appearance, causing cosmetic concern 2. Compress on surrounding structures causing difficulty with breathing and/or swallowing 3. Produce excessive hormone causing thyroid hormonal imbalance (commonly hyperthyroidism, rarely hypothyroidism) Radiofrequency ablation is a minimally-invasive approach (through 1mm incision over the skin), using low-temperature energy delivered via a wand/probe directed under ‘live’ ultrasound-guidance to the thyroid nodule, causing cell death and shrinkage. Nodule must be confirmed via ultrasound-guided FNAC/biopsy to be definitely/unequivocally non-cancerous first (at least once or even twice in some d o u b t f u l cases). Main usages are for large visible benign (may or may not cause compressive symptoms) or hyperfunctioning nodules causing hyperthyroidism. Most useful in cases with visible thyroid swelling (but not too big though) or especially those with bilateral swelling for which a total thyroidectomy would have been inveitable before the advent of RFA. Usage in thyroid cancer or metastatic lymph node cases not recommended as first-line treatment but subject to case-to-case review and discussion. What are the advantages of RADIOFREQUENCY ABLATION OF THYROID NODULE? Advantage of thyroid nodule RFA : Can be done under local anesthesia, reducing risk of general anesthesia (maybe a safer option especially for patients with multiple medical illness who cannot tolerate surgery like diabetes, severe heart failure) Usually done as a daycare (6-hours admission) procedure Much lesser side effects like vocal cord nerve injury, and no risk of hypocalcemia as compared to resection surgery Can be repeated few months later for additional shrinkage effect. Can effectively shrink down the nodule to a smaller less obvious size Does not take away the opportunity for future resection surgery (if patient eventually requires/requests for total nodule resection) Coverage available for medical insurance policyholders May be cheaper than the resection surgery What are the disadvantages of RADIOFREQUENCY ABLATION OF THYROID NODULE? Disadvantage of thyroid nodule RFA : All thyroid surgeries come with risk of bleeding, vocal cord nerve injury, neighbouring structures injury though RFA comes with much less of that The nodule remains hence RFA is not an actual removal of the nodule but rather to shrink down a large visible nodule or to reduce its hyperfunctioning. Hence large thyroid or those with compressive effects already may not be suitable candidates.
An ideal case for RFA : bilateral solid/amost solid thyroid nodule in the right lobe(left pic) and left lobe  (right pic) Thyroid swelling in different shapes and sizes (L-R): Small colloid cyst, large colloid cyst and a multinodular thyroid mass (goitre)  © Vincent Tan ENT © Vincent Tan ENT Ultrasound-guided Fine-needle aspiration cytology (FNAC) of a thyroid gland mass (red arrow) Ultrasound-guidance showing the tip of the needle (red arrow) in the mass in question confirming accurate targeting Ultrasound-guidance showing the shaft of the needle (red arrow) in the mass in question confirming accurate targeting Interventional     Thyroidology
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INTERVENTIONAL thyroidology
VINCENT
Ear, Nose and Throat (ENT), Thyroid, Head and Neck
Biopsy & Surgery Specialist Clinic
Committed to YOUR Well-being
As we handle many different treatment methods for different thyroid diseases, we shall be able to also suggest alternative treatment options for you, from conservative, watch-and-wait option, shrinkage to total removal/resection of the lesions. We will assess each patient on a unique case-to-case basis for diagnosis and treatment, hoping for the best outcome in each case. COMMITTED TO YOUR WELL-BEING.
What is PERCUTANEOUS ETHANOL INJECTION (PEI) ABLATION OF THYROID NODULE? Many thyroid gland lumps can be cystic in nature, meaning it is filled with fluid. Under ultrasound guidance, the exact nature of the content can be studied. The cystic content can be suctioned (aspirated) out therefore causing the cyst to be smaller (i.e decompressed) though however this depends largely on the viscosity of the fluid content. If watery enough to be able to be sucked through needle, then decompression can be achieved. Treatment options for symptomatic benign cystic or predominately cystic thyroid nodules include needle aspiration, minimally invasive techniques like percutaneous ethanol (alcohol) injection (PEI) besides surgical resection. A prior biopsy or cytology study is mandatory to prove the benign nature of the nodule. With PEI under ultrasound guidance, , the ethanol results in permanent tissue damage with subsequent necrosis, fibrosis and thrombosis of cyst wall blood vessels.
An ideal case for PEI : a cystic thyroid nodule that can be aspirated (cyst content as on the left pic)
What is INTERVENTIONAL THYROIDOLOGY ? I nterventional thyroidology is an emerging field that uses percutaneous (i.e. through the skin), image-guided procedures to treat thyroid diseases. Interventional thyroidology 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 precutaneous ethanol injection (PEI) ablation and ultrasound- guided radiofrequency ablation (RFA) of specific types of indicated specific thyroid diseases.
What is RADIOFREQUENCY ABLATION OF THYROID NODULE? Introducing a fairly new, US-FDA approved treatment for thyroid nodules Radiofrequency Ablation (RFA). In the past, RFA thermal ablation technique has been successfully used for treatment of cancer nodules in the liver, lung, kidney, and bone. Some explanation on thyroid nodules and its implications, role of ultrasound-guided Fine Needle Aspiration Cytology (FNAC)/biopsy, the usages, advantages and disadvantages of RFA of the thyroid nodule procedures. The thyroid gland is an important organ over the neck that produces hormones that control many bodily functions However, the thyroid gland commonly has nodules within that can enlarge. The nodules maybe solid or cystic (fluid-filled) or a mixture of both. They are commonly non-cancerous though they can be cancerous on rare occasions. Problems with the nodules: 1. Enlarge and may be obvious on appearance, causing cosmetic concern. 2. Compress on surrounding structures causing difficulty with breathing and/or swallowing. 3. Produce excessive hormone causing thyroid hormonal imbalance (commonly hyperthyroidism, rarely hypothyroidism). Radiofrequency ablation is a minimally-invasive approach (through 1mm incision over the skin), using low-temperature energy delivered via a wand/probe directed under ‘live’ ultrasound-guidance to the thyroid nodule, causing cell death and shrinkage. Nodule must be confirmed via ultrasound-guided FNAC/biopsy to be definitely/unequivocally non-cancerous first (at least once or even twice in some doubtful cases). Main usages are for large visible benign (may or may not cause compressive symptoms) or hyperfunctioning nodules causing hyperthyroidism. Most useful in cases with visible thyroid swelling (but not too big though) or especially those with bilateral swelling for which a total thyroidectomy would have been inevitable before the advent of RFA. Usage in thyroid cancer or metastatic lymph node cases not recommended as first-line treatment but subject to case-to-case review and discussion. What are the advantages of RADIOFREQUENCY ABLATION OF THYROID NODULE? Advantage of thyroid nodule RFA : Can be done under local anesthesia, reducing risk of general anesthesia (maybe a safer option especially for patients with multiple medical illness who cannot tolerate surgery like diabetes, severe heart failure) Usually done as a daycare (6-hours admission) procedure Much lesser side effects like vocal cord nerve injury, and no risk of hypocalcemia as compared to resection surgery Can be repeated few months later for additional shrinkage effect. Can effectively shrink down the nodule to a smaller less obvious size Does not take away the opportunity for future resection surgery (if patient eventually requires/requests for total nodule resection) Coverage available for medical insurance policyholders May be cheaper than the resection surgery What are the disadvantages of RADIOFREQUENCY ABLATION OF THYROID NODULE? Disadvantage of thyroid nodule RFA : All thyroid surgeries come with risk of bleeding, vocal cord nerve injury, neighbouring structures injury though RFA comes with much less of that The nodule remains hence RFA is not an actual removal of the nodule but rather to shrink down a large visible nodule or to reduce its hyperfunctioning. Hence large thyroid or those with compressive effects already may not be suitable candidates.
© Vincent Tan ENT Ultrasound-guided Fine-needle aspiration cytology (FNAC) of a thyroid gland mass (red arrow) Ultrasound-guidance showing the tip of the needle (red arrow) in the mass in question confirming accurate targeting Ultrasound-guidance showing the shaft of the needle (red arrow) in the mass in question confirming accurate targeting
Thyroid swelling in different shapes and sizes (L-R): Small colloid cyst, large colloid cyst and a multinodular thyroid mass (goitre)  © Vincent Tan ENT An ideal case for RFA : bilateral solid/amost solid thyroid nodule in the right lobe(left pic) and left lobe  (right pic) Interventional     Thyroidology
INTERVENTIONAL thyroidology
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APPOINTMENT:  +603-3377 7864 +6012-3760 728 VINCENT EAR, NOSE & THROAT, THYROID , HEAD AND NECK SURGERY SPECIALIST CLINIC  VINCENT
Ear, Nose and Throat (ENT), Thyroid, Head and Neck
Biopsy & Surgery Specialist Clinic
Committed to YOUR Well-being
Copyright Dr.Vincent Tan 2021