when removal (and lifelong treatment) can be avoided – breaking latest news

Eliminate the tumor, or just keep it under control, e save the thyroid, which secretes hormones essential for the regular performance of many functions of our body. this is the goal to be achieved in the vast majority of patients who receive the diagnosis of thyroid cancer. Having a thyroid nodule (or even more than one) is a far from uncommon episode, especially for women, but it is inevitable that many people fear the worst when faced with an ultrasound that highlights its presence. In fact, several studies have shown that the majority of benign and asymptomatic nodules kept under control for years prove to be harmless in the end. And even when it comes to cancer, thyroid cancer in general (and some variants in particular) behaves well: that is, in practice these nodules do not grow, do not give local or distant metastases, in short, do no damage or cannot cause patient’s death.

Why then remove the whole thyroid gland, or only a part, if not necessary?

If the thyroid gland is surgically removed, the production of thyroid hormones ceases and patients who have had a total thyroidectomy must be prescribed lifelong thyroid replacement therapy after surgery — answers Roberto Valcavi, president of the Thyroid nodule therapies (Tnt) association, which promotes the #Saveyourthyroid campaign to disseminate information on innovative and minimally invasive approaches to the treatment of nodular thyroid pathologies that allow the removal of the gland to be avoided -. In Italy they are performed annually over 40,000 total thyroidectomy surgeries, 80% of which were women, but only in 2% of cases the healthy part of the gland is saved. Today there are several effective and safe thermoablative approaches, with many advantages for patients.

It is estimated that every year approx 13,200 Italians (3,300 males and 9,900 females) they will get sick of thyroid cancer. The most affected are young women (under 50), among whom this tumor is the most frequent after breast cancer. According to the most recent statistics, 10-year survival is over 97%. In fact, in the vast majority of cases, it is a matter of very little dangerous microcarcinomas that go very often observed without intervention, in order not to unnecessarily subject patients to the undesirable consequences of therapies. it is in this context that the new treatment options, alternatives to the scalpel, are inserted: The consequences of classical surgery can now be overcome in many cases thanks to advanced technologies such as radiofrequency ablation, which is the most widely used ablative system – clarifies Valcavi, a specialist in Endocrinology -. Other related technologies include microwaves, lasers and focused ultrasound.

What are the differences between the various techniques?

Hyperthermal techniques (radiofrequency, microwave, laser, focused ultrasound or Hifu) are all based on the principle that heat destroys the cells of any tissueincluding cancer. enough that 60 degrees are reached for one second to obtain the coagulation of cellular proteins. The differences consist mainly in the temperatures reached and in the diversity of the applicators used. In any case, the lesion destroyed by the heat is largely reabsorbed, giving way to inert fibro-scar tissue. This determines the reduction or disappearance of the nodule. All hyperthermal technologies, then, make use of the use of images obtained by means of real-time ultrasound to view the lesion undergoing ablative surgery.

When are they indicated?

Radiofrequency thermal ablation or related techniques indicated for the treatment of solid or partially cystic benign nodules thyroid gland, thyroid cyst, self-functioning thyroid adenoma (besides reducing the mass of the nodule, normalizes the function of the gland) and for malignant papillary tumors less than one centimeter in size or lymph node metastases unresponsive to radioiodine n eligible for surgery.

What are the benefits for patients?

Minimally invasive ultrasound-guided thermoablative approaches involve several improvements, compared to standard surgery (removal of all or part of the gland): absence of scars, preservation of the thyroid gland and its normal functioning, therefore no need for the patient to take therapy with thyroid hormones. There are then minimal side effectsno intubation for general anesthesia, nor hospitalization, with a much faster recovery to daily activities.

What are the side effects of these techniques?

With appropriate technique, side effects and complications of thyroid ablative therapies are minimal and easily preventable. The most common are a sense of discomfort in the neckwhich resolves spontaneously in a short time, ed skin bruising, which disappear in about a week. Rarer (and in any case transient, lasting a few days) are neck pain, loss of voice and bleeding. Within about three days, the patients return to their usual occupations.

Do you need hospitalization?

No hospitalization is required for radiofrequency ablative therapies. The surgery takes place on an outpatient basis, under sedation and local analgesia, without the need for general anesthesia with intubation. After a couple of hours of observation, the patient is discharged with analgesic therapy, in the immediate postoperative period, to avoid pain. The procedure has a variable duration from a minimum of 15 to a maximum of 120 minutes based on the size and number of nodules, as well as individual patient variables.

Is one session enough or do you need more cycles?

Reoperations are usually not necessary, but (if needed) the minimally invasive ablative techniques can be repeated on particularly voluminous nodules or in cases of recurrence. Importantly, a classic lobectomy or total thyroidectomy surgery is unimpeded by a previous ablative procedure. Radiofrequency reduces the volume of benign thyroid nodules by an average of 70-80%. within a year and this is generally sufficient to make the compression symptoms disappear and to obtain excellent aesthetic results. As for papillary thyroid microcarcinomas, they are destroyed and in 80-100% of cases there is no visible trace on ultrasound.

Are they reimbursed by the National Health Service?

Unevenly across the country: some regions and Local Health Authorities allow thermal ablation completely paid for by the NHS, others do not. A wider diffusion of these technologies will lead, hopefully, to their widespread recognition as happened for the same procedures used for the treatment of tumors of other organs (liver, lung, bone, for example). Even at the insurance level, the reimbursement is still limited to some companies and not always total.