Thyroid Nodule Ablation in Lucknow

A thyroid nodule is a lump within the thyroid, the butterfly-shaped gland at the front of the neck. Nodules are very common, and many are found by chance on an ultrasound done for another reason. Most are benign: fluid-filled cysts, or overgrowths of normal thyroid tissue. A small number are cancer, which is why every nodule is assessed.

Most nodules cause no symptoms. A large one can show as a visible lump, a feeling of tightness, trouble swallowing, a change in the voice or a cough. A few nodules make too much thyroid hormone and cause a racing heart, weight loss or sweating. A blood sample sent for thyroid hormone levels picks this up.

Ablation destroys tissue without removing it, so there is no specimen to examine afterwards. A cancer has to be ruled out before treatment, not after. The usual path has three parts.

• Thyroid blood tests to see how the gland is working. A thyroid profile of T3, T4 and TSH is part of our thyroid package.
• A detailed neck ultrasound that looks at the size, shape, edges, make-up and any tiny calcium spots in the nodule. These features are scored to show how suspicious it looks.
• An FNAC biopsy, in which a fine needle takes cells from the nodule under ultrasound and a pathologist examines them. See FNAC and ultrasound-guided FNAC.

Ablation is considered only if the result is benign. Some doctors ask for the FNAC to be repeated when the first result is unclear. A nodule that is cancerous or looks suspicious is managed differently, often with surgery, by an endocrine or thyroid surgeon.

Ablation damages the nodule from inside, and the body slowly absorbs the treated tissue, so the nodule shrinks over the following months. Under ultrasound, a thin needle or electrode is placed through the skin into the nodule. Radiofrequency, microwave or laser energy heats the tissue, and the needle is moved across the nodule until it is treated. The neck is numbed with local anaesthetic, and fluid is sometimes injected around the thyroid to protect nearby structures.

A nodule that is mostly fluid is treated differently. The fluid is drained and a little alcohol is injected into the cavity, which is called ethanol ablation. It is a standard option for cysts that keep refilling.

Shrinking is gradual and is checked with repeat ultrasound. The amount varies from nodule to nodule, and some nodules regrow.

Ablation may be considered for a benign nodule that causes pressure, swallowing difficulty or a visible lump, when a person prefers not to have surgery or is not fit for it. In selected cases it is also used for a nodule that makes too much hormone. The other choices are these.

• Watching, with a repeat ultrasound from time to time. This is the right choice for most benign nodules.
• Surgery, removing half or all of the thyroid. It removes the nodule completely and gives a specimen, but it needs an operation and may need thyroid tablets afterwards.
• Radioactive iodine or medicines, for a nodule that makes too much thyroid hormone.
• Draining a cyst, if it is a simple fluid-filled lump.

Ablation is generally not advised for suspicious nodules, for very large nodules that extend behind the breastbone, during pregnancy, or when a bleeding problem cannot be controlled. A nodule close to the nerve of the voice box needs particular care, and a vocal cord that already does not move changes the plan. The small glands that sit behind the thyroid are a different matter, covered under parathyroid ablation.

Ablation is gentler than thyroid surgery, but it is not free of risk, and it cannot promise the result you hope for. The nodule may shrink only partly, symptoms may stay, and some nodules grow back and need more treatment.

• Pain or a feeling of heat in the neck during the procedure, and soreness for a few days afterwards.
• Bruising or bleeding in the neck, and rarely a larger collection of blood.
• Hoarseness from irritation of the voice-box nerve. It is usually temporary, and a lasting voice change is rare. Your doctor may check your vocal cords before and after.
• A skin burn at the needle site, or a small change in thyroid function.
• Fever or infection, which is rare.
• With alcohol treatment, pain if some alcohol leaks into the tissue around the nodule.

Your endocrinologist, physician or thyroid surgeon should be part of the decision, and so should you. Thyroid blood tests, neck ultrasound and FNAC reports are all needed, and the team goes through them with your referral before anything is planned.

Whether the ablation is then carried out at our centre or elsewhere, and by whom, is confirmed only after that review. Neck ultrasound is done at the centre, and the team confirms the FNAC arrangements when you book. The interventional radiology page lists the other image-guided procedures.