Thyroid Nodules Treatment Without Surgery
What are thyroid nodules?
A thyroid nodule is an abnormal collection of thyroid cells and tissue forming a physical lump or growth in the thyroid gland. Majority of these are age related and are benign in nature. However, it is important to investigate the thyroid nodules once detected to ensure they are not cancerous. If the nodules are found to be benign, there are options of non surgical treatment. Read more on thyroid nodules
Most nodules will need to be evaluated with an ultrasound scan as well as a needle biopsy depending on the ultrasound findings. If found to be cancerous, surgery is the standard treatment of choice. Read more on thyroid cancer surgery
How to treat benign thyroid nodules?
Unlike thyroid cancer, there are many treatment options for benign thyroid nodules. This includes surgery and non-surgical alternatives.
Surgery
Some of these benign nodules may cause symptoms especially when they are large. Patient may experience slight discomfort or difficulty when swallowing. Some patients may be concerned with the bulge on the neck that is caused by the nodule. Standard treatment will be a hemithyroidectomy which involves surgical excision of the diseased half of thyroid gland. If there are multiple nodules involving both lobes of the thyroid gland, total thyroidectomy will be the preferred surgical option.
NON SURGICAL TREATMENT
There are a few other options to treat benign thyroid nodules without surgery that may be suitable for a selected group of patients. It is however important to note that these are not recommended for cancer cases.
Below are a few possible options of thyroid nodules treatment without surgery.
Needle Aspiration
Needle aspiration may be considered as an appropriate first line therapy for a simple thyroid cyst. This is most suitable for nodules that are completely cystic in nature. The procedure can be done using a small needle at the bedside with or without the use of ultrasound. The fluid might be sent for cytology analysis by your doctor. However, there is a risk of recurrence and re-accumulation of the fluid. A repeat aspiration can be performed but surgical excision should be considered for further recurrence.
High-Intensity Focus Ultrasound
High-Intensity Focus Ultrasound (HIFU) is a treatment using therapeutic ultrasound to rapidly heat up the tissue of the thyroid nodule to about 85°C in order to “melt” it away. The effect persists after the treatment and the nodule will gradually become smaller as the body continues to break down the “melted” tissue.
The procedure can be performed on an outpatient basis under local anaesthesia with/without sedation. You will be lying on your back with your neck extended and the probe will then be on your neck over the nodule. The treatment will commence after precise planning by your doctor on the computer system. Each pulse will last for 8 seconds follow by a pause before the next pulse. The cycle will continue until the treatment is completed, typically lasting 20 to 30 minutes depending on the size of the nodule. You will feel some pain during the pulse phase but it is often manageable with sedation
You will be discharged after the procedure with some painkillers and will be reviewed in the clinic in 1 to 2 weeks. Your doctor will then repeat the ultrasound scan to monitor the shrinkage of the nodule which is typically around 60-70% over the next 6 to 12 months. HIFU is a good option for patients with benign nodules who prefer a non-invasive and scarless treatment modality.
Radiofrequency ablation
Radiofrequency ablation (RFA) is a minimally invasive technique that involves introducing a special needle into the nodule with the help of ultrasound. Heat energy is delivered into the nodule through this needle. The procedure will take around 30 minutes and you can be discharged shortly after. The nodule will slowly shrink over time.
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Dr LEE Kuok Chung
Senior Consultant General Surgeon
Subspeciality interest: Colorectal, Advanced Endoscopy and Robotic Surgery
Dr TAN Wee Boon
Senior Consultant General Surgeon
Subspeciality interest: Thyroid, Hernia and Endocrine Surgery
Dr KIM Guowei
Senior Consultant General Surgeon
Subspeciality interest: Upper Gastrointestinal, Bariatric and Robotic Surgery
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