Thyroid
Dr. Mahesh Krishna specializes in the diagnosis and treatment of thyroid disorders, including hypothyroidism, hyperthyroidism, goiter, and thyroid nodules. Using advanced medical techniques, he ensures accurate diagnosis, effective treatment, and personalized care to restore hormonal balance and overall well-being. With a patient-centric approach, he focuses on providing the best possible outcomes for thyroid health.
Laser And microwave in thyroid surgeries
Lasers
The widespread use of thyroid ultrasonography has resulted in a higher detection of thyroid nodules in the adult population. Currently, the cytological diagnosis provided by ultrasound-guided fine-needle aspiration (US-FNA), an easy, noninvasive procedure, prevents the need for diagnostic surgery, and the majority of patients may be followed up.
Most thyroid nodules are asymptomatic, and their volume stays approximately stable over time. After a benign cytological diagnosis, most of them are observed without therapy.
However, some nodules (about 10%), mainly the larger ones at diagnosis, gradually increase their dimensions,
causing local discomfort or compressive symptoms. After a generally protracted follow-up, these steadily growing nodules are eventually managed with thyroidectomy.
Thyroid surgery is an invasive and expensive treatment. It is followed by cosmetic damage due to the cervical scar—unless more complicated surgical approaches are employed and by the frequent necessity of substitution therapy.
US-guided thermal ablation [laser ablation (LA)] with a laser source could be easily performed on thyroid lesions with minimal discomfort and risk for the patient.
Ultrasound (US)- guided ablation techniques performed on the thyroid gland using different energy sources [besides LA, radiofrequency ablation (RFA), microwave ablation (MWA), and high-intensity focused ultrasound (HIFU)] have been proposed and are currently used in routine clinical practice.
Selection of cases
A benign cytologic diagnosis must be confirmed with two US-guided FNA prior to thermal ablation.
When ultrasonographic features of the thyroid nodule are highly suspicious for benignity (e.g., spongiform and purely cystic nodules), the second fine-needle aspiration biopsy (FNAB) may be omitted.
Cytologic assessment is not needed in hyperfunctioning nodules proved by scintigraphy). Further clinical and cytological evaluation should be performed in cytologically benign nodules with suspicious US features to rule out the risk of overlooking a malignant lesion.
Treatment of cytologically indeterminate nodules (Bethesda III and IV categories) with laser appears inappropriate. In malignancy, thermal ablation of the target lesion may be oncologically incomplete and is associated with the risk of tumor progression, locally or at a distance.
Efficacy
LA results in a clinically significant volume reduction, paralleled by amelioration of local complaints, up to 80% in most cases.
LA results in a clinically significant volume reduction, paralleled by amelioration of local complaints, up to 80% in most cases. Volume reduction has been stable for many years, but LA should aim at the most complete ablation of the target nodule to prevent regrowth.
Periprocedural complications are rare, the risks of cosmetic damage or thyroid function disorders are almost nonexistent, and the influence on quality of life is favorable.
Microwave in thyroid
Microwave ablation is a technique for generating heat within structures to destroy cells via a probe placed through the skin. In the case of the thyroid, this means using that heat energy to burn symptomatic nodules to reduce their size.
Benefits
The primary benefit of microwave ablation is a minor procedure performed through an incision around 1cm in size.
It is also performed as a day case procedure under local anesthetic with the patient awake and is usually approximately half an hour long. The patient is also able to go home within a few hours rather than staying overnight.
As it is minimally invasive, patients can return to normal activities quickly and avoid a hospital stay.
The risks of nerve injury, long-term thyroid replacement therapy, and scarring are all substantially less than surgery.
Risk
As with any procedure there are risks associated, and it is difficult to entirely remove them with a number of the risks the same as for surgery but occurring less frequently.
These include bleeding, infection and of a need for emergency surgery including removal of the thyroid, voice change, skin burns, decreased thyroid function or nodule rupture.
In some cases, the nodules can regrow but results have suggested this is after a long time if it were to occur. The likelihood of these risks are low.
Patient selection
Patients who have symptomatic thyroid nodules over 2cm (but not extending into the chest) and are able to lie flat can be considered for the procedure.
Single nodules can be treated in a single session whilst some patients with multinodular goiters may require a few sitting over a period to treat as fully as possible.
Some patients may still be more suited to surgery rather than ablation and decisions are made jointly with the surgical and endocrine teams.
