Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And today, our discussion is about a non-surgical procedure for the management of thyroid nodules called pulsed field ablation.

Joining me is Dr. Thomas Fahey. He's an attending surgeon at New York Presbyterian Weill Cornell Medical Center, the Chief of Endocrine and Minimally Invasive Surgery, and a Professor of Surgery at Weill Cornell Medicine.

 Dr. Fahey, it's such a pleasure to have you join us today. First, tell us a little bit about thyroid nodules themselves, what are they, how common are they, and when should someone be concerned. How do we even know if we have one?

Thomas Fahey, MD: Thank you, Melanie. It's a pleasure to be with you here today. So, thyroid nodules are in fact quite common. And once you get to be older age, and by that, I mean even older than 50, if you went looking for thyroid nodules, you could almost be certain to find one. Most of the time, these are just small nodules that are of no consequence and need no further workup. But larger nodules sometimes will require further investigation.

Melanie Cole, MS: How would you know? Is this an incidental finding? Would your primary care be the person where you start? How would you even know if you had them?

Thomas Fahey, MD: So, thyroid nodules frequently are found as a consequence of imaging for other conditions. A neck CT for neck pain, a carotid ultrasound to investigate your carotid arteries, or they can be palpated by your primary care physician. In that situation, when they are palpable, it usually will precipitate additional investigation, usually with an ultrasound of the neck.

Melanie Cole, MS: So Dr. Fahey, tell us about that new service offered by Endocrine Surgery called pulsed field ablation. What is that? What does it entail?

Thomas Fahey, MD: So, thyroid nodules, if they are symptomatic, symptoms from thyroid nodules can either be because of local compressive symptoms where they're causing pressure in the area or thyroid nodules can sometimes be making too much thyroid hormone, and that's something that's called a toxic nodule, a nodule that's making you hyperthyroid. In those situations, the standard treatments for thyroid nodules like those in the past have been either to surgically move them or, in the case of hot nodules, sometimes to treat them with radioactive iodine.

Recently, and by that I mean over the past 10 years or so, other techniques have been developed called ablative techniques. Traditionally, these techniques were based on heat. So, a very small needle is placed into the nodule and heat is generated, and this is either by radiofrequency or by microwave, and the nodule is destroyed by heat. The newest application of ablation technology is called pulsed field ablation. This is not dependent on heat. And so therefore, it is safer and can be used in nodules that are in more difficult or dangerous places where heat cannot be used for fear of damaging surrounding structures.

Melanie Cole, MS: That's so cool, Dr. Fahey, what you're able to do. I mean, what exciting advancements there are. And Weill Cornell Medicine is ahead of the curve here, can you tell us a little bit about how this even came about that you're doing these? Because they're not very commonly done or widely done around the country.

Thomas Fahey, MD: So, as technology has advanced, ablation has become a preferred treatment option for some nodules, because it is able to avoid surgery. Traditionally, surgery would require removal at least of half the thyroid, which leaves you both with a surgical scar, as well as the possibility of needing to take thyroid hormone replacement in the case where your thyroid is not able to fully provide the thyroid hormone for your body. So, ablation is a more targeted treatment. The advantage of pulsed field ablation is that it depends on the use of electricity, where essentially cells are zapped. In this situation, you do not use heat like it is used with radiofrequency or microwave ablation. And so, it is a safer procedure than radiofrequency or microwave ablation.

Melanie Cole, MS: How did Weill Cornell decide to start using this? How were you involved in that?

Thomas Fahey, MD: Here at Weill Cornell, we have a long history of treating nodules with ablation. Usually or in the past, it was radiofrequency or microwave ablation. Because radiofrequency and microwave ablation are not able to treat all nodules that are eligible for ablation because of the location of the nodule being too close to critical structures like the nerve that supplies the muscles of your voice, or the esophagus or the trachea, we were looking for other options.

Pulse Biosciences developed this very unique and novel technique to use electricity to treat and to ablate these types of nodules. The advantage is that with the electrical stimulation that essentially zap cells, you do not have the same capacity to damage surrounding tissues, including the nerve that supplies the muscles of your voice. So, we were selected as a center to use the pulsed field ablation, to trial the pulsed field ablation because of our experience with ablation in the past.

Melanie Cole, MS: How effective is it, Dr. Fahey, in shrinking or eliminating those thyroid nodules? And you mentioned thyroid function and possibly being on medication. Does it affect thyroid function or hormone levels?

Thomas Fahey, MD: As far as efficacy, it is relatively new, but the early data indicates that it is equally effective to radiofrequency or microwave ablation in treating thyroid nodules. It does not affect thyroid hormone production by the surrounding normal thyroid tissue, as was the case with radiofrequency or microwave ablation, but it will decrease thyroid hormone production by the nodule that's being treated. So for the instance where you have a nodule that's making too much thyroid hormone, the nodule itself will be eliminated or treated, and therefore you will no longer need to be treated for hyperthyroidism.

Melanie Cole, MS: Tell us about patient selection and how do you decide which patients would be good candidates for PFA.

Thomas Fahey, MD: So, not everybody is a candidate for pulsed field ablation, just like not everybody is a candidate for radiofrequency or microwave ablation. In pulsed field ablation, very large nodules may have some benefit, but it is unlikely that they will be eliminated. Sometimes they may require more than one treatment. Nodules that are suspicious for cancer or are cancer, if they are more than one centimeter, probably also should not be treated using pulsed field ablation or probably either radiofrequency or microwave ablation. So, the indications for treatment with pulsed field ablation are very similar to those nodules that were treated using either radiofrequency or microwave ablation, with the advantage that it is safer and able to access nodules that are sitting towards the back of the thyroid or in the area where the nerve to your vocal cord runs.

Melanie Cole, MS: Dr. Fahey, tell us a little bit about the procedure itself and the patient experience. Is this an outpatient procedure? Is it long? Tell us a little bit about the procedure and the day of.

Thomas Fahey, MD: So the procedure is typically done in the operating room, but it is an outpatient procedure. It is relatively quick. The total stay in the hospital is probably only three or four hours. We do the procedure in the operating room because we find that that has the maximal comfort for the patient. Most patients will not experience anything during the procedure. If you are completely awake, you would feel the electrical stimulation, which can be disconcerting for some patients. So it is done in the operating room with sedation so that you have both the best outcome as far as my ability to treat the nodule as well as the best outcome as far as your comfort.

Melanie Cole, MS: Can this be repeated or does it need to be repeated if the nodule comes back or doesn't shrink as much as you would like it to?

Thomas Fahey, MD: Yes. Nodules can be treated again. And sometimes, for larger nodules, they require a second treatment. How many or what percentage of the time that is going to be necessary is not really worked out yet at this point. Many times patients will have symptomatic relief after just one treatment, even if the nodule does not shrink to the degree that we would like it to, or that the patient would like it to. So, it can be repeated if necessary.

Melanie Cole, MS: If someone's nervous, Dr. Fahey, about treating the thyroid nodule, how do you work with them in that shared decision-making to make the decision to try PFA or one of your other options for treatment?

Thomas Fahey, MD: That is a great question, Melanie. So, PFA is not for everybody. Ablation is not for everybody. Really what I try to determine when I'm talking to you is, or talking to the patient is really what is the goal of the treatment. If the goal of the treatment is to eliminate the nodule forever and never have to worry about it again, then probably surgery is the best option.

If the goal of the treatment is to relieve symptoms or to prevent the continued production of too much thyroid hormone, even if it requires a second treatment and avoiding surgery, then ablation and PFA in particular is a great option. So, it really depends ultimately on what the patient's goals are for the treatment.

Melanie Cole, MS: Do you have any final thoughts, Dr. Fahey, for patients that are worried about their thyroid nodules and looking to you for the expert that you are, and some great advice?

Thomas Fahey, MD: So, I think ablation is something that will change and has been changing the face of thyroid nodule treatment over the past five to ten years. Pulsed field ablation is the next step, and I believe a safer and a better option than radiofrequency ablation for most types of nodules. Whether or not it will have the same efficacy in the long run still is yet to be determined, but the early indications are that it will be just as effective.

Melanie Cole, MS: Thank you so much, Dr. Fahey, for joining us today and sharing your incredible expertise for patients. Thank you again. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointment at Weill Cornell Medicine.

That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review back to Health on Apple Podcasts, Spotify, iHeart, and Pandora. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. So many great podcasts there. I'm Melanie Cole. Thanks so much for joining us today.

Promo: Every parent wants what's best for their children, but in the age of the internet, it can be difficult to navigate what is actually fact-based or pure speculation. Cut through the noise with Kids Health Cast featuring Weill Cornell Medicine's expert physicians and researchers discussing a wide range of health topics, providing information on the latest medical science.

Finally, a podcast to help you make informed choices for your family's health and wellness. Subscribe wherever you listen to podcasts. Also, don't forget to rate us five stars.

Disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast, and any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures. And Weill Cornell Medicine does not endorse, approve, or recommend any product, service, or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.