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Scott Webb (Host): I'm Scott Webb. And today, we're discussing thyroid nodules and treatment options, including radiofrequency ablation with Dr. Scott Santeler. He's an interventional radiologist with Carle.

Doctor, it's nice to have you here today. We're going to talk thyroid nodule ablation, and what does that mean, right? But essentially, we're going to really dive into minimally invasive thyroid nodule treatments and specifically RFA. But before we get to RFA, what does that mean, right? Tell us about it. Give us some background on thyroid nodules and maybe the treatment options that are available before we get to RFA.

Dr. Scott Santeler: Sure. Yeah. RFA itself is a technology, and it's a tool that we use to manage thyroid nodules. But thyroid nodules themselves are incredibly common. There are tons and tons of people who deal with thyroid nodules. And, thankfully, you know, 90% of these are benign lesions in people, meaning, like, this is not a cancer, but it's a growth inside people's thyroid gland, and it can produce a number of effects.

I mean, one thing is that it can actually be visible. You know, when people describe a goiter, that's enlargement of the neck and the thyroid gland. And usually, what's happening there is there are nodules forming inside the thyroid. And some people certainly are uncomfortable with the appearance, but it can also create difficult sensations with swallowing, and it usually requires some continued surveillance.

So, people will often have to have yearly ultrasounds. And certainly anytime there's a change, even though cancer is very rare, people typically need a biopsy after that. And to have to go through that year after year is understandably uncomfortable and a thing that people are looking for a solution.

Host: Yeah, I see what you mean. So then, let's talk about RFA and what that is and why patients might and/or you might suggest that this is the right path.

Dr. Scott Santeler: This is a great technology. It's actually been around for a long time. I mean, we're talking about 10 years, but it's becoming increasingly mainline in the way to manage this for people. Traditionally, if someone had really symptomatic thyroid nodules, they'd actually need an incision, and they would need, you know, to have either part of the thyroid removed or potentially the whole thing.

In some circumstances, you know, people used to take radioactive iodine for what would be called ablation. And what's really advantageous about this technique is I can use the same skills I have used for almost two decades to simply biopsy to actually affect a treatment for people. So, what's involved with it. You know, I can talk about some of the physics of RFA that might be kind of more boring, to be honest. But really, what we're doing is we're inserting a needle into the troublesome nodules and through a radiofrequency ablation, essentially, we're going to do a point treatment with a needle of the nodule.

And when we are doing this, effectively, it's burning the nodule, like we're scarring it on the inside. And by doing that, we can get significant volume reduction. I mean, papers will publish slightly different results. But essentially, you know, you can get up to 80% volume reduction in these things, which significantly decreases the nodule size, obviously.

And in addition to that, it also stabilizes it typically. So, the recurrence rates, you know, are as little as zero or, you know, I've seen them as high as sometimes 34%. But overall, we're shrinking the entire nodule itself. And by reducing the volume and the pressure and the space it's taking in there, that's why we can get a cosmetic result, we can get a symptomatic improvement, and all done through just a needle hole

Host: Yeah, it's really amazing. And I'm sure prospective patients or patients whose providers have said, "Hey, we might consider RFA as a treatment option for you," maybe they want to know, like, what's involved in terms of, like, where do you do this procedure? How long does it take? Is there any sort of recovery or limitations?

Dr. Scott Santeler: That's really one of the ideal parts about this. I mean, traditionally, a surgery was general anesthesia. The surgeons would have to make an incision once you're asleep. You have to recover from the incision. This is an outpatient procedure. Where I happen to do it is the same place I actually do biopsies for a thyroid. So, it's a procedural room that we have at Carle.

I usually like to have people have a little bit of sedation medicine. You know, sometimes people refer to that as twilight or moderate sedation. I actually want to be able to talk to people. I want to hear how their voice is going. We scrub and clean the skin like we would for any invasive procedure. And then, I poke with a needle, and I like to be upfront about that with people. But it's a local medication, a numbing medicine. Same thing you'd have if you were having dental work, lidocaine. And then, through that area, I insert the needle looking with ultrasound at the same time. So, everything I'm doing is actually live. I'm watching where I have the needle in the nodule itself.

And then, we have a machine. It basically is attached to a machine that is running, through the needle, and then that affects the change. And I can actually watch it live. I turn it on and off as I do this. And in a lot of ways, what I'm doing is I'm trying to use this point source that I'm watching, and I sort of build up the ablation. It's sort of like tracing or drawing where I'm creating the ablation, which means to destroy stuff. Like, I'm basically building that up. And I'm watching it the whole time. And I can do multiple nodules in one sitting. Typically, per nodule, it's taking me about all the way to the person getting out of the room about forty-five minutes

Host: Yeah. And you mentioned earlier that you can reduce the size by perhaps as much as 80%. So, I just want to kind of maybe finish up here and get a sense from you. Like, okay, so you've reduced the size of a nodule through the ablation, the RFA. And you've, let's say, cut it down 80%. Is that nodule going to come back? Is it going to regrow to its original size? Is there a sort of a permanency to this? How does this work?

Dr. Scott Santeler: Our intention is that it's permanent. You know, I always would love to have a permanent result. And, you know, for the cohort of patients that I've been treating so far, we've been very happy with the results. The patients have been quite happy. I'm always trying to balance the benefit and the risk. You know, it is better to undertreat an area to minimize risks. I mean, we should probably talk about the risks.

One of the risks is changes to the voice. There's an important nerve that goes to your voice box that I don't want to injure. So, I would intentionally undertreat around that area to avoid that possibility, which is incidentally why I was saying I like to hear people be able to talk to me.

So in general, this is considered permanent, and it has permanent results. If there are areas that we've under-ablated, theoretically, they could grow with time. You know, and I have not seen that in the cohort of patients that I have. You know, so I would be quoting literature about that, which I've seen as high of a regrowth rate as 30%, though that's not been my experience. But I want to be accurate with what's reported in the literature. But in general, this is permanent. The intention is it's going to stabilize nodules that had grown before. And by doing that, if we can show that the nodules aren't changing in time, then people can be freed from the need to do a repeat biopsy.

So when people have nodules, they often have multiple nodules, and then they're in some sort of surveillance. And the challenge for them, again, is like sometimes almost yearly biopsies of some of these things if they change or grow. So if we can stabilize that, not only can we get symptomatic improvement, but we can free them from that cycle.

Host: Well, that's perfect. I know we're going to speak again soon about chronic osteoarthritic knee pain, and I am one of those people. I'm raising my hand saying, "Yes, please. Let's talk about that." But for now, thank you so much.

Dr. Scott Santeler: All right. Thank you

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.