Enlarged thyroid: heat instead of a scalpel

Larissa Melville completed her traineeship in the editorial team of . After studying biology at Ludwig Maximilians University and the Technical University of Munich, she first got to know digital media online at Focus and then decided to learn medical journalism from scratch.

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Munichneck tightness, feeling of pressure, difficulty swallowing, hoarseness - benign thyroid nodules also cause symptoms. An operation brings relief, but is associated with risks. Newer methods are gentler and safer: With the so-called thermal ablation, the knot is tackled with heat instead of a scalpel.

Doctors surgically remove the annoying lumps around 90,000 times a year under general anesthesia in Germany alone. But this carries risks, such as an injury to the vocal cord nerve or disorders of the cardiovascular system.

Rays and electricity

But there is a good alternative that is slowly establishing itself in Germany: thermal ablation. In this procedure, the diseased tissue is heated strongly. The treated cells die. And then the body breaks them down on its own.

The heating can be done in different ways: with the help of microwave rays, ultrasound rays or alternating current. Compared to surgery with a scalpel, the procedures are safe, have few side effects and also show good cosmetic results. In addition, they can all be carried out on an outpatient basis.

Using microwaves against the knots

Enlargement of the thyroid gland can be successfully treated with microwave ablation. In this procedure, the doctor inserts a needle-sized probe through the skin under local anesthesia. The microwaves radiate directly into the diseased thyroid tissue and kill it. The procedure is usually completed in less than 15 minutes. "Today we can even offer this therapy to patients with advanced thyroid cancer," says Dr. Hüdayi Korkusuz, specialist in radiology at the University Hospital Frankfurt, where the procedure was first used in Germany. In order not to damage critical regions such as the recurrent nerve, this method requires a sufficient safety margin between the changed and healthy tissue.

Gentle ultrasound therapy

Heat therapy using high-intensity focused ultrasound (HIFU) is even gentler. This method is carried out under light local anesthesia and is non-invasive, i.e. no needle has to be inserted and an incision is not necessary. Instead, the doctors direct a highly focused ultrasound beam from the outside at the node. It heats the tissue to around 85 degrees. “Only the thyroid nodule is destroyed, the healthy thyroid tissue is spared and retains its normal function,” explains Prof. Frank Grünwald, Director of the Clinic for Nuclear Medicine at the University Hospital in Frankfurt. The entire treatment takes between 15 and 45 minutes depending on the size of the lump.

Alternating current heats the tissue

Another method is inexpensive radio frequency ablation. In this procedure, the diseased tissue is heated by high-frequency alternating current, which is directed through the skin into the thyroid nodule using a small probe under local anesthesia. The procedure is finished in ten to fifteen minutes.

The indication determines the procedure

Which of the three procedures is most suitable and whether a combination with radioiodine therapy or surgery is appropriate depends on the type and size of the thyroid nodule. In most cases, small nodules are treated with ultrasound and larger ones with microwave or radio frequency ablation. “This enables us to achieve a volume reduction of around 50 to 55 percent,” Grünwald told the Ärztezeitung.

One speaks of thyroid nodules when individual areas arise within the thyroid gland in which the cells multiply and / or enlarge. Around 20 million people are affected in Germany. Some nodes will stop growing at some point, while others will grow larger. It is also possible that a thyroid nodule regresses on its own. Most of the time, the lumps are harmless, but they are often associated with unpleasant discomfort. In some cases, however, the growths are malignant. Therefore, thyroid nodules should always be examined by a doctor.

Sources:

Press release of the University Hospital Frankfurt from November 21, 2013; 02/25/2014; October 31, 2014 and December 4, 2014

Korkusuz H. et al .: Microwave ablation (MWA) in combination with radioiodine therapy (RIT) in the treatment of thyroid nodules. Nuclear Medicine 2013

Doctors newspaper from April 14th, 2015

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