ENT associates is proud to introduce radiofrequency ablation and scarless thyroid/parathyroid surgery to the practice courtesy of Dr. Dipan D. Desai, a board-certified surgeon with fellowship training in Head and Neck Endocrine Surgery.
In addition to our team’s years of expertise in traditional thyroid and parathyroid surgery, these new, advanced treatments offer additional cutting-edge options for patients with endocrine disorders. We are excited to be among the first practices in Florida to offer these treatments to our patients.

RADIOFREQUENCY ABLATION (RFA) FOR THYROID NODULES

Thyroid nodules are common growths within the thyroid gland. Although most thyroid nodules (up to 90% of all cases) are benign (noncancerous), even benign thyroid nodules can enlarge over time and cause symptoms. Common symptoms can include a visible neck mass, neck pressure when lying flat, and trouble swallowing.

Historically, the only effective treatment for enlarging thyroid nodules was to undergo a partial or total thyroidectomy. Because most thyroid nodules are not life-threatening, many patients choose to live with them rather than undergo surgery. Although thyroid surgery is common and very safe in experienced hands, there are possible side effects including a permanent scar, low calcium levels and need for thyroid hormone replacement.
Radiofrequency ablation (RFA) of the thyroid received FDA approval in 2018 and is now being performed across the country. Today, RFA presents a new, minimally invasive option for suitable candidates who prefer to avoid surgery, and the need for thyroid hormone medication.

How does RFA work?

RFA treatment utilizes a radiofrequency probe to apply energy and heat directly to a thyroid nodule. This thermal energy begins to destroy thyroid tissue and leads to nodule size reduction. RFA technology has long been successfully used in the U.S. to treat bone, liver, and kidney tumors without the need for surgery or radiation exposure.

Due to its precise energy delivery, RFA offers a minimally invasive treatment option for benign, symptomatic thyroid nodules with substantially lower risks and downtime than traditional thyroid surgery.

How is RFA performed?

The procedure is performed by a specially trained thyroid surgeon, endocrinologist, or radiologist. The procedure does not require general anesthesia or sedation, and it is most commonly performed in an outpatient clinic. To start, a local anesthetic is applied to the skin and around the thyroid gland. Oral medications may be given to help with any mild discomfort.

Once ready, an ultrasound is used to insert the thin, needle-like probe through the neck into the enlarged nodule. The physician guides the instrument through the entire nodule systematically to safely treat as much of the nodule as possible. Depending on location and size, up to three thyroid nodules can be treated in a single RFA session.

Radiofrequency energy is emitted from the tip of the needle to heat up the cells in the nodule, causing the cells to die. Over time, the body’s immune system removes these cells, causing the thyroid nodule to shrink.

Typically, substantial reduction can be achieved with a single RFA treatment session. However, very large nodules (>5cm) can require additional RFA treatments to achieve optimal size reduction.

Who is a candidate for RFA?
RFA is typically appropriate for patients with benign (non-cancerous) thyroid nodules that are causing symptoms or cosmetic problems.  Typically, two fine needle biopsies with benign results are required. Nodules that are suspicious for thyroid cancer are not suitable candidates for RFA treatment. In these cases, your physician may recommend surgery or active surveillance.

It is important to understand that because the procedure does not surgically remove the nodule completely, you may need to have additional ultrasounds of your thyroid in the future.

What are the benefits of RFA?

Unlike traditional surgery, which involves removing part of the thyroid gland, RFA maintains thyroid integrity and function. This is one of the most significant advantages of the treatment. Other benefits include:

• Outpatient procedure with no significant downtime or hospitalization
• Minimally invasive technique under local anesthesia
• Preserves your healthy thyroid tissue and allows it to function normally without the need for thyroid medication
• Shorter recovery time
• No visible scarring
• Significantly reduces nodule size with a low complication rate
• Can improve quality of life for patients with symptomatic nodules

What are the risks and potential complications?

RFA is a safe procedure with low risk. In rare cases, side effects can occur, such as:

• Changes in your voice or hoarse voice. This is typically temporary, but can be permanent in rare cases
• Bleeding or bruising under the skin
• Infection
• Nodule rupture or drainage
• Cough
• Skin burns
• Vomiting or nausea
• Temporary thyroid overactivity

What happens after the RFA procedure?

Patients are monitored in clinic for 30 minutes after the procedure prior to returning home. Most patients return to work the following day and return to their regular activities after 72 hours. For the initial 72 hours, light activity is recommended (avoid exercise or heavy lifting).

Patients may experience modest bruising, swelling, and soreness that subside within a week. Any post-treatment discomfort is easily managed with ice packs and pain reliever (acetaminophen) in pill form.

What are the long-term expectations from RFA treatment?

As the immune system removes treated thyroid nodule cells, the nodule shrinks in size over the first 12 months after treatment. As the nodule shrinks, symptoms are likely to improve. Patients often notice a reduction in size approximately 1-3 months after the procedure. However, patients should not expect 100% resolution of the nodule. Instead, the goal is to reduce the size of the nodule to relieve the symptoms associated with it.

SCARLESS (TRANSORAL) THYROID / PARATHYROID SURGERY

Traditional thyroid and parathyroid surgery can leave a modest scar at the base of the neck. Although the incision is placed within a skin crease and typically heals well, the resulting scar is permanent and can be visible.
With this approach, the surgeon accesses the gland(s) through small incisions inside the patient’s lip. The surgery is performed with endoscopic cameras and instruments, similar to abdominal surgery, and leaves no visible scars.

How is scarless surgery performed?

The surgery is performed laparoscopically through small incisions on the inner surface of the lower lip without any external neck incisions. The inner lip incisions heal completely, leaving no evidence of surgery.

Scarless operations are carried out under general anesthesia, so patients are completely asleep during the procedure. Just like traditional thyroid surgery, nerve monitoring technology is used to protect the vocal cord nerves.

The surgeon makes three small incisions on the inner surface of the lower lip to insert surgical instruments and a high-resolution camera. These small incisions are closed after the thyroid gland is removed, leaving no external scarring.

Who is a candidate for scarless surgery?

Anyone who needs an operation to remove the thyroid or parathyroid glands is a potential candidate for the procedure. However, some limiting factors exist, such as the size of the affected gland and the underlying condition.

People with the following diagnoses may be candidates for scarless surgery:

• Benign thyroid nodule less than 4 cm
• Thyroid cancer less than 1.5 cm
• Thyroid removal for benign conditions

Our physician carefully evaluates each potential patient’s specific condition to recommend the safest and most effective treatments options.

What are the benefits of scarless surgery?

The benefit most often cited by patients is that the approach avoids any external, visible scars to the neck or other body areas, while allowing safe and complete removal of thyroid or parathyroid glands. Studies have shown that scarless procedures are equally successful and safe as traditional approaches.

What are the risks and potential complications?

The scarless approaches is considered highly safe and effective. As with any surgery, however, there are standard potential risks. The scarless option does not increase the overall risk of complication.

What happens after the procedure?

The procedure requires an overnight hospital stay. Patients are typically discharged the following morning.

For a few days following the procedure, patients can expect to have a sore throat, a scratchy voice, and a stiff neck/lip. Bruising on the chin and neck can also occur, and typically resolves quickly. Most patients do not require prescription-strength pain medication for more than two to three days after surgery, at which point an over-the-counter pain reliever like ibuprofen is sufficient. As with traditional surgery, most patients return to work 1-2 weeks after surgery.

It is important to maintain good oral hygiene post-surgery, being careful not to disturb the small, dissolvable stitches. An antibiotic and prescription strength mouthwash will be prescribed after surgery, which should be used for the first week post-surgery.