Guatr, known as the abnormal enlargement of the thyroid gland, is a health condition. This condition is usually manifested by swelling in the neck area. Patients may experience difficulty swallowing and breathing. Additionally, aesthetic concerns can also arise. In addition to traditional surgical methods, there are non-surgical alternative treatment options available.
Microwave, radiofrequency, or cryoablation techniques such as nodule ablation and embolization offer effective solutions for treating goiter with minimal invasive interventions. These techniques allow patients to return to their normal life more quickly and generally leave no scars. The biggest advantage of the procedure is that as healthy thyroid tissue is preserved, lifelong hormone usage is not required.
| Treatment Method | Non-Surgical Goiter Treatment |
| Indications | Enlarged thyroid nodules, symptomatic goiter, cosmetic issues, patients unsuitable for surgery |
| Procedure Description | In an interventional radiology procedure, ablation (radiofrequency, microwave, cryoablation) or ethanol injection is performed on thyroid nodules under ultrasound guidance |
| Advantages | Minimal invasive, does not require general anesthesia, rapid recovery, no hospitalization, no medication after the procedure |
| Complications | Infection, bleeding, hoarseness, thyroid dysfunction, re-growth of nodules after the procedure |
| Success Rate | High success rate; provides effective results when applied with correct indications |
| Recovery Process | Return to work the next day, avoid heavy physical activities for a few weeks, control at 1, 3, and 12 months |
| Alternative Treatments | Surgical thyroidectomy, medication therapy (thyroid hormones), radioactive iodine treatment |
| Preparation and Precautions | Detailed imaging before the procedure (ultrasound, thyroid scintigraphy), local anesthesia during the procedure, post-procedure care and follow-up |
| Epidemiology | Thyroid nodules are more common in women, the frequency increases with age, the incidence on ultrasound is 30-70%, and the cancer risk is 5-10% |
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
Non-Surgical Goiter Treatment: Radiofrequency and Microwave Ablation Methods
Among non-surgical methods for treating thyroid nodules, radiofrequency and microwave ablation stand out. Radiofrequency ablation began to be used in 2006, followed by microwave ablation being added to treatment options in 2010. Both methods provide painless treatment and a quick return to daily life for patients. These treatment methods:
- Have high patient satisfaction rates.
- Are considered safe and effective alternatives.
- Have been featured in numerous scientific articles worldwide.
Microwave delivers higher energy and can treat larger nodules.
Applicability of Non-Surgical Goiter Treatment Methods
This method is particularly effective for symptomatic thyroid nodules. Patients often experience symptoms such as pain, a sensation of pressure, and difficulty swallowing. Breathing difficulties and coughing may also be observed. Imbalances in thyroid hormones and cosmetic concerns are also reasons for the application of this treatment method. It is particularly applicable in the following cases:
- Nodules larger than two centimeters (for nodules over 8-10 cm, two sessions may be required)
- Papillary cancers smaller than two cm
- Recurrent papillary thyroid cancer cases
- Cases with lymph node involvement
- Cold or hot (toxic) nodules
- Parathyroid adenoma
Recent studies have shown that this method can be safely used for small-sized papillary thyroid cancers. This treatment has been successfully applied in patients with these features.
Non-Surgical Goiter Treatment: Procedure Steps
The non-surgical treatment of thyroid nodules with ultrasound-guided microwave ablation offers an effective solution. First, the neck area is numbed with local anesthesia. Then, a thin needle is directed to the thyroid tissue. During the procedure, an increase in temperature is achieved in the nodule through controlled alternating currents from the needle tip. This heat causes the nodule to shrink over time. Continuous ultrasound imaging is used during the burning process to ablate the nodules while leaving healthy parts intact.
The main steps of the procedure:
- Numbing the neck area,
- Placing the needle under ultrasound guidance,
- Treating the nodule with heat.
As a result, the treated nodules begin to shrink from the first month, with a 40-50% volume reduction in three months, and 80-90% volume reduction after one year. This method allows patients to return to their daily lives the next day and leaves no surgical scars.
Benefits of Non-Surgical Goiter Treatment
Non-surgical goiter treatment is an advanced method for treating abnormal thyroid enlargement. This method offers several advantages for patients. First, the treatment is completed in 30 minutes, allowing patients to return to their normal routines the same day.
This procedure, performed under local anesthesia, eliminates the need for general anesthesia, thus avoiding risks associated with anesthesia.
- Painless procedure: Patients do not experience significant discomfort during the treatment process.
- No scars: No incisions or wound marks are left on the skin.
- Rapid recovery: After treatment, patients can quickly return to daily activities.
- No thyroid hormone use required as normal thyroid tissue is preserved.
- Low risk of complications: The side effects of the treatment are minimal, making the procedure reliable.
- Repeatable: In case of recurrence, the treatment can easily be repeated and does not interfere with previous treatments.
These advantages create significant differences compared to surgical treatment. Non-surgical methods alleviate both physical and aesthetic concerns for patients. The treatment is well received by most patients with high satisfaction rates.
It offers cosmetically satisfying results and leaves no stitches or scars, making the treatment and recovery process more comfortable for patients.
Potential Risks of Non-Surgical Goiter Treatment Methods
Although non-surgical goiter treatment methods are minimally invasive, they carry some risks. Complications may rarely develop during the treatment. Local or systemic toxic effects may occur due to local anesthetics injected during the procedures.
Additionally, local reactions such as skin burns may occur at the treatment site. After microwave ablation or embolization procedures, pain may arise in the treated area. On the other hand, fragmentation of the treated nodules can occur, which may require additional treatment.
- Permanent hoarseness (1%)
- Nerve damage
- Decrease in thyroid hormone levels
- High blood pressure
- Vomiting
These effects are observed in a very small percentage of patients and possible complications are quickly managed.
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Is It Necessary to Treat Nodules and Goiter?
It is important to treat goiter because this health issue can lead to serious complications over time. Intervening while thyroid nodules are small can significantly reduce the difficulties encountered later. As untreated nodules grow:
- Cosmetic issues increase,
- Difficulty eating and swallowing may occur,
- Hoarseness may become permanent,
- Breathing problems such as shortness of breath may develop,
- Nerve damage may occur due to pressure on the nerve.
- The need for a second session for treatment may increase.
These issues become more complex over time, and the treatment process becomes more difficult. Therefore, early intervention minimizes these risks and preserves the patient’s quality of life.
Non-Surgical Goiter Treatment: Biopsy and Ultrasound Requirements
In the non-surgical goiter treatment process, a biopsy is required first. This step is essential to determine potential cancerous conditions and to create the correct treatment plan. Before starting treatment, it is crucial to understand whether the thyroid nodules are benign or malignant.
Additionally, a thyroid ultrasound examination performed no more than three months before the procedure is required. This ultrasound:
- Shows the current condition of the thyroid gland in detail,
- Determines the location and size of the nodules to be treated,
- Helps clearly identify the area where the procedure will be applied.
Thus, every stage of the treatment process is carefully planned.
Details of Thyroid RF-MWA Ablation for Toxic Nodules Treatment
Recent scientific studies have shown that the thyroid RF-MWA ablation method is an effective alternative for hormone-producing toxic nodules. This method is particularly recommended for young patients. After surgical and radioactive iodine treatments, a decrease in thyroid hormones may require lifelong medication. Therefore, the RF-MWA ablation procedure stands out as a minimal invasive approach. This treatment:
- Has a lower risk of complications after surgery.
- Accelerates the patient’s return to normal life.
- Does not leave permanent scars.
Non-Surgical Goiter Treatment Procedures
The treatment process begins with your preparation in sterile conditions. You are placed on a bed in a sterile environment. Local anesthetics and sedative medications are administered intravenously. General anesthesia is not used at this stage due to the risks involved.
First, an ultrasound is used to assess the condition of the thyroid gland. During this planning phase, the location of the nodules and surrounding structures are identified. Measures are taken to ensure you do not feel pain during the procedure with local anesthesia. The following methods are used to perform the procedure:
- Local anesthetics may cause a burning sensation, but it is very brief.
- Protective areas are created by injecting sugary water into surrounding tissues (hydrodissection) to preserve critical structures.
- Electric shock-like sensations or popping sounds during burning are normal and temporary, and do not cause pain.
- If you feel pain during the burning process, the energy level is adjusted to provide relief.
- The sound of air bubbles in the nodules indicates the procedure is being carried out correctly.
After the procedure is completed, ice is applied to the neck area to reduce swelling. The following conditions may occur after the procedure:
- Tingling, numbness, swelling, and slight bleeding may occur within the first 24 hours.
- Difficulty swallowing, discomfort during eating, and coughing may temporarily occur.
You will be sent home within 1-2 hours after the procedure. Your treatment process continues with regular follow-up and medication.
Mediastinal Goiter Extending into the Chest Cavity, Large Nodules, and Basedow Graves Disease: Non-Surgical Treatment: Embolization
For goiter and nodules extending into the chest cavity, the most effective non-invasive treatment method is thyroid artery embolization. This method blocks the affected vessels to reduce the size of the nodules. All nodules are treated in the same session; there is no risk of hoarseness, but if the nodule is predominantly cystic, the effect may be limited. This method reduces the blood supply to nodules that microwave needles cannot reach.
These procedures have been developed as alternatives to surgery, prioritizing patient comfort. The following steps summarize the main outline of this treatment process:
- First, thyroid artery embolization is performed; this procedure cuts off the blood flow to the nodules.
- After embolization, the nodules are expected to shrink.
- In cases of very large goiters, microwave ablation treatment can be applied to the remaining nodules.
- Basedow-Graves disease is also a condition where the thyroid tissue enlarges and secretes excessive hormones; embolization helps shrink the gland and reduce hormone levels.
These treatment methods offer effective solutions for goiter and nodules extending into the chest cavity.
Non-Surgical Goiter Treatment: Microwave Method and Cancer Risk
When the microwave method is used in non-surgical goiter treatment, there may be concerns about cancer development in the ablated area. However, after this method, the ablated tissue gradually shrinks and hardens. The formation of fibrotic tissue prevents the development of new blood vessels; thus, the environment necessary for cancer is eliminated.
The risk of cancer development in the treated area is as follows:
- In the ablated area: There is no risk of cancer, as the tissue becomes fibrotic over time.
- In untreated thyroid tissue or other nodules: The likelihood of cancer development proceeds as in normal individuals.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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