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January is Thyroid Awareness Month! The thyroid is a small gland responsible for producing hormones that play a crucial role in many of the body’s systems — from cells and tissues, to organs like the heart, brain, liver, and kidneys. The thyroid helps regulate and control things like metabolism - how your body uses energy. It also involves other processes like regulating body temperature, heart rate and blood pressure. Dysfunction occurs when the thyroid produces either too much or too little thyroid hormone. Either can disrupt healthy functioning of vital organs — leading to a wide range of symptoms. Thyroid Nodules: Unexpected Discoveries by Physicians, Loved Ones, and Even Hairdressers! Everyday new thyroid nodules are discovered by their physicians, family, friends, and even their hairdressers! Some people have symptoms related to the size of the nodules, which directs them to seek medical consultation. Others have no symptoms but learn about these nodules after undergoing radiologic testing for different reasons. The majority of thyroid nodules are benign. Observe Thyroid Awareness Month! Take the Thyroid Neck Check Prepare : Grab a hand-held mirror and a glass of water. Position : Using the mirror, focus on the lower front area of your neck, above the collarbone, and below the voice box (larynx). This is where your thyroid gland is located. Perform the Check : Tip your head back, take a sip of water, and swallow. While swallowing, observe your neck in the mirror. Look for any bulges or protrusions. Remember, don't confuse the Adam's apple with the thyroid gland. Follow Up : If you notice any bulges, consult your physician. You might have an enlarged thyroid gland or a thyroid nodule. Share this flyer: Encourage Friends and Family to Get Tested If you know someone who frequently feels cold, has trouble sleeping, or experiences difficulty swallowing, it might be time to suggest they speak to their doctor about thyroid dysfunction. It's easy to overlook "small" issues like dry skin, but a thyroid test could lead to quicker treatment and better health outcomes. Request an appointment at the Thyroid Nodule Treatment Center! The most readily available modality for evaluating these is the ultrasound. The test is easily performed and avoids radiation exposure. The physician performed exam is much better than reviewing the still images saved on prior examinations. The study is easily repeated with no potential harm to the patient. Request an appointment at the Thyroid Nodule Treatment Center! Expertise in RFA: Dr. Richard Harding's 100+ Successful Treatments View TNTC's graphic data of successful RFA thyroid nodule volume reduction results Patient Success Stories Dr. Richard Harding has performed over 100 RFA treatments. With thyroid ultrasound there are several features in benign nodules that we like to identify to consider a lesion low risk of malignancy. When some of these features are absent, the nodule would be considered indeterminate, or potentially at risk for malignancy. These nodules will be tested using a biopsy to help the physician guide therapy. Not all nodules have the favorable ultrasound characteristics, and yet they may prove benign on biopsy. Additionally, a small percentage of nodules can have favorable findings on ultrasound and yet can be found to have papillary thyroid cancer. It is for these reasons that routine surveillance ultrasound is initiated once a nodule grows to about 15 mm in largest dimension.

The 2025 CPT codes have a disappointing effect on insurance coverage for patients receiving thyroid nodule radiofrequency ablation (RFA). American Medical Association (AMA) RVS Update Committee (RUC) In January 2024, the American Medical Association (AMA) RVS Update Committee (RUC) evaluated two new reporting codes for valuation: 60660 for percutaneous radiofrequency ablation of thyroid nodules and 60661 as an add-on code for additional nodule(s). The Centers for Medicare & Medicaid Services (CMS) suggested adopting the RUC’s recommended values in the proposed CY 2025 Medicare Physician Fee Schedule (MPFS). Here are the key changes: New CPT Codes : Two new codes have been introduced specific to radiofrequency ablation techniques for thyroid nodules. The second code is reported only when additional lobes are treated. CPT code 60660  covers the ablation of one or more thyroid nodules in a single lobe or the isthmus, including imaging guidance. CPT code 60661  is an add-on code for the ablation of additional nodules in another lobe, including imaging guidance, radiofrequency. Valuation and Reimbursement : The Centers for Medicare & Medicaid Services (CMS) have accepted the recommended work Relative Value Units (RVUs) for these codes. This means that the reimbursement rates for these procedures have been updated to reflect their complexity and resource requirements. Single Use Limitation : CMS has directed that these codes be used only once per treatment session, regardless of the number of nodules treated in each lobe. This is different from previous codes for biopsy procedures, which allow separate reporting for each lesion. Impact on Billing Procedure : These changes aim to streamline the coding and billing process, ensuring that patients receive appropriate reimbursement for their treatments. The new codes are intended to standardize the reporting of thyroid nodule RFA procedures, making it easier for healthcare providers to document and bill for these services accurately. Impact on Insurance Coverage Over the last 5 years, numerous patients have been anticipating the development of this code to seek treatment with insurance coverage benefits. Regrettably, the new code has established reimbursement rates too low for RFA to remain financially viable in an outpatient clinic setting. Overall, the new CPT codes are designed to improve the accuracy and efficiency of billing for thyroid nodule RFA procedures. Ultimately this has negligible benefit to patients who will be required to supplement their insurance coverage in order to receive desirable, non-surgical alternatives to treat thyroid nodules and to preserve their thyroid functioning without requiring medication for the rest of their lives. Although the assignment of specific CPT® codes represents acceptance of thyroid RFA as a standard medical procedure, it does so without awarding sufficient insurance coverage to significantly increase its adoption. Read more:

Dr. Richard Harding explains the benefits of Thyroid Nodule RFA on the Sonoran Living segment of Arizona ABC15! Watch the video segment for a special offer from TNTC! Thyroid nodules commonly develop in humans and are variable in size, shape and location. Most of these growths are not cancer but may create symptoms of discomfort over time depending on the size, and location in the neck. Enlargement of the thyroid gland can commonly present with many symptoms including neck swelling, difficulty swallowing, neck pressure, choking, foreign body sensation, or simply a dry cough. Most patients experiencing such issues are sent to a surgeon for thyroid removal. Thyroid surgery is commonly performed safely and has its benefits for the patients; however, the removal of these abnormal glands also removes normal functioning thyroid tissue and produces a surgical scar. A non-surgical approach, Thyroid RFA, can now be performed to quickly alleviate these symptoms through a small skin puncture. This new technique involves applying high frequency electrical energy at the tip of a probe to produce a small focus of heat. Under ultrasound guidance, these probes can be advanced to the edges of the lesions. The abnormal tissue is destroyed safely with pinpoint accuracy. This process also protects the normal thyroid tissue and adjacent neck tissue. After 26 years of experience with thyroid ultrasound and thyroid surgery, Dr. Harding , a general and endocrine surgeon, has been performing thyroid RFA in selective patients at the Thyroid Nodule Treatment Center. He introduced this innovative procedure to Arizona in 2020. In addition, he has introduced numerous minimally invasive and robotic procedures in Arizona, including endoscopic transoral thyroidectomy. His success in these treatments has changed the lives of many. Evaluation for this thyroid RFA requires a neck ultrasound as well as a few thyroid biopsy tests. These are conveniently offered at the Thyroid Nodule Treatment Center location. Patients who have been reluctant to undergo thyroid removal now have an option to be treated with an office procedure that provides immediate relief. Patients suffering from huge nodules that push on the windpipe and create symptoms of choking and suffocation can quickly improve without surgical removal of the thyroid gland. Those patients experiencing trouble with swallowing as a result of a large nodule also improve dramatically as the thyroid shrinks in size. Patients enjoy not only seeing their neck swelling improve, but also avoid surgery, and the introduction of thyroid medication to their daily routine. The surgical scar and short-term recovery can be completely avoided. After a successful thyroid RFA procedure, periodic follow ups for thyroid nodular disease become celebrations of success. All of this is available at the Thyroid Nodule Treatment Center. About Dr. Richard Harding Dr. Harding is a member of distinguished organizations, including American Association of Endocrine Surgeons The American College of Surgeons Arizona Chapter American College of Surgeons Phoenix Surgical Society Maricopa County Medical Society Arizona Medical Association North American Society for Interventional Thyroidology Dr. Harding has taught residents in his role as Associate Professor in Surgery, Creighton University School of Medicine, Assistant Professor of Surgery, University of Arizona College of Medicine, and trainings he has provided on Thyroid Radiofrequency Ablation (RFA). Dr. Harding has dedicated a large part of his practice to endocrine surgery. He has performed over 2000 endocrine operations for adrenal, thyroid and parathyroid conditions. He is active in the American Association of Endocrine Surgeons. He is the first surgeon in the Southwest to perform a Transoral Endoscopic Thyroidectomy, which has the benefit of leaving no visible surgical scar. He is very familiar with the latest treatment guidelines for both thyroid and parathyroid diseases. He now also performs a Laparoscopic posterior adrenalectomy which significantly decreases recovery time for adrenal surgery conditions. For patients' convenience, many diagnostic tests and minor procedures can be performed in his office, including diagnostic ultrasound, ultrasound lymph node mapping, and ultrasound guided thyroid nodule biopsies. Dr. Harding also treats simple and complex hernias, gallbladder disease, colon cancer, diverticulitis, and gastroesophageal reflux conditions. He performs many abdominal wall reconstructions in patients who have complex hernia conditions, usually resulting from prior surgical procedures or prior failed ventral hernia repairs. Richard J. Harding, MD has been evaluating and removing hundreds of thyroid glands per year for the past twenty-eight years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. Dr. Richard Harding has performed 100 RFA treatments in the last 4 years.

The North American Society for Interventional Thyroidology (NASIT) forwards innovation, collaboration and progress, in addition to physician and patient education. NASIT is a multidisciplinary group of physicians interested in Interventional Thyroidology with a two-fold mission: To promote safe integration of ablative technologies into clinical practice To promote a collaborative environment that supports education and research efforts in Interventional Thyroidology Dr. Richard Harding has been serving as the Program Chair for NASIT Annual Meetings. This year, Dr. Harding is presenting a session on Perithyroid and Deep Cervical Block, as well as sitting on the panel discussing key technologies in the field. NASIT 2024 Program Agenda Dr. Harding is delighted to reconnect with colleagues at the Annual Meeting in Sarasota, Florida. In addition to serving as the Program Chair for NASIT, Dr. Harding is a member of distinguished organizations, including American Association of Endocrine Surgeons The American College of Surgeons Arizona Chapter American College of Surgeons Phoenix Surgical Society Maricopa County Medical Society Arizona Medical Association Dr. Harding has taught residents in his role as Associate Professor in Surgery, Creighton University School of Medicine, Assistant Professor of Surgery, University of Arizona College of Medicine, and trainings he has provided on Thyroid Radiofrequency Ablation (RFA). Dr. Harding has dedicated a large part of his practice to endocrine surgery. He has performed over 2000 endocrine operations for adrenal, thyroid and parathyroid conditions. He is active in the American Association of Endocrine Surgeons. He is the first surgeon in the Southwest to perform a Transoral Endoscopic Thyroidectomy, which has the benefit of leaving no visible surgical scar. He is very familiar with the latest treatment guidelines for both thyroid and parathyroid diseases. He now also performs a Laparoscopic posterior adrenalectomy which significantly decreases recovery time for adrenal surgery conditions. For patients' convenience, many diagnostic tests and minor procedures can be performed in his office, including diagnostic ultrasound, ultrasound lymph node mapping, and ultrasound guided thyroid nodule biopsies. Dr. Harding also treats simple and complex hernias, gallbladder disease, colon cancer, diverticulitis, and gastroesophageal reflux conditions. He performs many abdominal wall reconstructions in patients who have complex hernia conditions, usually resulting from prior surgical procedures or prior failed ventral hernia repairs. Richard J. Harding, MD has been evaluating and removing hundreds of thyroid glands per year for the past twenty-eight years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. Dr. Richard Harding has performed over 90 RFA treatments in the last 4 years.

Currently the evaluation of the thyroid nodules is covered by insurance companies. However, radiofrequency ablation of thyroid nodules is new and is not considered a recognized benefit. As the exciting success of thyroid RFA is recognized, the insurance companies are paying and reimbursing more frequently. This therapy will save the patient and the entire healthcare system a considerable amount of money. As the healthcare community and patients continue to advocate for this non-surgical solution of benign thyroid nodules, the availability to utilize insurance healthcare benefits will increase. The American Association of Endocrine Surgeons and Society of Interventional Radiology are both working towards getting this valuable treatment more readily accepted by more insurance companies You can demand an appeal to an insurance coverage denial. TNTC has gathered the following suggestions and background material to assist you. These resources are also available on our Insurance Page. Suggestions to appeal insurance denial How to Appeal Denied Claims from the National Association of Insurance Commissioners Insurance Authorization Letter for Radiofrequency Ablation of the Thyroid Gland from the Thyroid Nodule Treatment Center. Ultrasound Guided Radiofrequency Ablation (RFA) of the Thyroid Gland Understanding Insurance Coverage Arizona Guidelines for Health Claim Appeal

January is Thyroid Awareness Month! The thyroid is a small gland responsible for producing hormones that play a crucial role in many of the body’s systems — from cells and tissues, to organs like the heart, brain, liver, and kidneys. The thyroid helps regulate and control things like metabolism - how your body uses engery. It also involves other processes like regulating body temperature, heart rate and blood pressure. Dysfunction occurs when the thyroid produces either too much or too little thyroid hormone. Either can disrupt healthy functioning of vital organs — leading to a wide range of symptoms. Everyday new thyroid nodules are discovered by their physicians, family, friends, and even their hairdressers! Some people have symptoms related to the size of the nodules, which directs them to seek medical consultation. Others have no symptoms but learn about these nodules after undergoing radiologic testing for different reasons. The majority of thyroid nodules are benign. The most readily available modality for evaluating these is the ultrasound. The test is easily performed and avoids radiation exposure. The physician performed exam is much better than reviewing the still images saved on prior examinations. The study is easily repeated with no potential harm to the patient. With thyroid ultrasound there are several features in benign nodules that we like to identify to consider a lesion low risk of malignancy. When some of these features are absent, the nodule would be considered indeterminate, or potentially at risk for malignancy. These nodules will be tested using a biopsy to help the physician guide therapy. Not all nodules have the favorable ultrasound characteristics, and yet they may prove benign on biopsy. Additionally, a small percentage of nodules can have favorable findings on ultrasound and yet can be found to have papillary thyroid cancer. It is for these reasons that routine surveillance ultrasound is initiated once a nodule grows to about 15 mm in largest dimension. Dr. Richard Harding has performed over 90 RFA treatments in the last 3 years.

The authors of a recent study, “Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules—Expanding Treatment Options in the United States,” published in the Journal of the Endocrine Society, found that RFA is safe and effective for treating benign thyroid nodules that cause problems due to their size or function. RFA is less risky than surgery and radioactive iodine, and it helps keep your thyroid working properly. In this study, doctors looked at how well radiofrequency ablation (RFA) worked for people with thyroid nodules. The study was done by reviewing the charts of patients who had RFA for their thyroid nodules at The Thyroid Clinic in Salt Lake City, Utah between November 2018 and January 2021. All patients had a physical exam, blood tests for thyroid function, and thyroid ultrasound before the procedure. Patients who had suspicious findings on the ultrasound had a thyroid biopsy. Patients who had metal hardware/ pacemaker, pregnancy, or suspicious results on fine-needle aspiration biopsy were not treated with RFA procedure. The nodules that were producing too much thyroid hormone causing hyperthyroidism and nodules that were mostly solid and were bothersome due to their size causing pressure in the neck and choking symptoms or cosmetic concerns were treated with RFA. The doctors found that RFA was successful in shrinking the nodules in most patients. In fact, the average decrease in size was 70% on initial evaluation. The volume of the smaller nodules decreased more than the larger nodules. Thyroid blood tests and hyperthyroid symptoms improved in the nodules making too much thyroid hormone. Thyroid function tests remained normal in the nodules that were treated due to size. There were no major complications. Thyroid nodules are small lumps that can grow in the thyroid gland, which is located in the neck. They are common and can be found in more than half of the population in the United States. Most of the time, they do not cause any problems. However, some nodules can be cancerous and require surgery. If the nodule is not cancerous, it can still cause problems if it grows too large and causes discomfort or changes the appearance of the neck. Another situation that can be harmful is when the nodule produces too much thyroid hormone, which can cause hyperthyroidism. In these cases, doctors may recommend surgery or radioactive iodine therapy to remove or shrink the nodule. Both treatments have some risks, such as hypothyroidism, which means that you may need to take thyroid hormone replacement pills for the rest of your life. Surgery can also leave a scar and sometimes affect your voice. In recent years, doctors have been using new treatments to help people with thyroid nodules. One of these treatments is called radiofrequency ablation (RFA). During RFA, a thin needle is inserted into the nodule under ultrasound guidance. Then, an electrical current passes through the needle, which generates heat and burns the cells inside the nodule. This causes the nodule to shrink and turn into scar tissue. The best part is that this procedure can be done in the doctor’s office without putting you to sleep with general anesthesia. However, only a few doctors in the United States are experts in administering this treatment. Dr. Richard Harding has performed over 90 RFA treatments in the last 3 years. Cited Research Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. “Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules—Expanding Treatment Options in the United States.” Journal of the Endocrine Society, vol. 5, no. 8, Aug. 2021, p. bvab110. DOI.org (Crossref), https://doi.org/10.1210/jendso/bvab110.

The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Dr. Richard Harding has been an American College of Surgeons Fellow since 1998. The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the ACS are referred to as "Fellows." The letters FACS (Fellow, American College of Surgeons) after a surgeon's name mean that the surgeon's education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College. Attending the American College of Surgeons Clinical Congress events in Boston, Dr. Harding is delighted to reconnect with residents that he has trained over the years as well as many colleagues from the professional organizations he is a member of. Dr. Harding has taught residents in his role as Associate Professor in Surgery, Creighton University School of Medicine, Assistant Professor of Surgery, University of Arizona College of Medicine, and trainings he has provided on Thyroid Radiofrequency Ablation (RFA). In addition to being a Fellow of the American College of Surgeons, Dr. Harding is also a member of other surgery organizations including North American Society for Interventional Thyroidology American Association of Endocrine Surgeons Arizona Chapter American College of Surgeons Phoenix Surgical Society Maricopa County Medical Society Arizona Medical Association Dr. Harding has dedicated a large part of his practice to endocrine surgery. He has performed over 2000 endocrine operations for adrenal, thyroid and parathyroid conditions. He is active in the American Association of Endocrine Surgeons. He is the first surgeon in the Southwest to perform a Transoral Endoscopic Thyroidectomy, which has the benefit of leaving no visible surgical scar. He is very familiar with the latest treatment guidelines for both thyroid and parathyroid diseases. He now also performs a Laparoscopic posterior adrenalectomy which significantly decreases recovery time for adrenal surgery conditions. For patients' convenience, many diagnostic tests and minor procedures can be performed in his office, including diagnostic ultrasound, ultrasound lymph node mapping, and ultrasound guided thyroid nodule biopsies. Dr. Harding also treats simple and complex hernias, gallbladder disease, colon cancer, diverticulitis, and gastroesophageal reflux conditions. He performs many abdominal wall reconstructions in patients who have complex hernia conditions, usually resulting from prior surgical procedures or prior failed ventral hernia repairs. Richard J. Harding, MD has been evaluating and removing hundreds of thyroid glands per year for the past twenty-eight years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. Let the most experienced thyroid surgeon in Arizona Save Your Thyroid!

The management of nodular thyroid disease has changed dramatically within the past decade. 1 Improvements in imaging technology as well as sophisticated cytologic testing can now differentiate low risk lesions from high-risk lesions without thyroid removal for pathologic confirmation. The confidence in this testing now allows us to treat and destroy symptomatic benign thyroid disease using highly technologic minimally invasive treatments. 2 Thyroid nodular disease is common and is present in all ages. Over half of the population over 50 years old will have at least one thyroid nodule. Most of these nodules will be asymptomatic and are discovered with imaging tests ordered for unrelated issues. The patients with larger nodules, however, are identified early due to visible and palpable neck deformity. Symptoms for patients with large thyroid nodules often include choking, swallowing difficulty, foreign body sensation, and hoarseness. Many patients simply notice a large lump in their neck either unilaterally or central. The evaluation of these patients begins with a designated neck ultrasound to include the thyroid gland and inspection of the central and lateral lymph node zones. The Thyroid Imaging Reporting and Data (TI-RAD) score in neck ultrasound helps to distinguish indeterminant thyroid lesions which could be at risk for malignancy. This score helps to guide which lesions should be considered for ultrasound guided fine needle aspiration biopsy. 3 Once the nodules’ cytology is confirmed, specific treatment options can be discussed. Indeterminant nodules and malignant disease is managed with surgical resection according to the American Thyroid Association Guidelines. Patient undergoing surgery by high volume thyroid surgeons have been demonstrated to have the lowest morbidity and shortest hospital stays.4,5 Symptomatic benign thyroid nodules can now be managed with percutaneous thermal ablation techniques. The three technologies effective for this include laser fiber ablation, radiofrequency ablation (RFA), and high frequency ultrasound ablation. Currently only laser fiber ablation and radiofrequency ablation (RFA) are available in the United States. With radiofrequency, the tissue immediately adjacent to the probe vibrates at such high frequency that heat is created, thus altering the cellular membrane proteins. The warmed tissue is unable to recover and is devitalized. Cooled RFA probes advanced under ultrasound guidance are used to safely destroy the entire thyroid nodule without injuring adjacent tissue. With laser ablation, a laser fiber is introduced into the middle of a nodule and the energy is applied for circumferential heating of the tissue, intentionally leaving a rim of untreated tissue. The adjacent normal tissue is preserved, and thyroid function is unaltered. This has the benefit of avoiding the potential complications of surgery, avoiding hypothyroidism, avoiding the surgical recovery, and avoiding a surgical incision. For many patients this non-surgical option is a highly desirable. The management of toxic or autonomous nodules (AN) is rapidly being transformed by this new technique. Destruction of a well-defined AN rapidly creates a euthyroid patient within days. The nodule also shrinks in size within weeks of treatment. No longer is it necessary to stay on marginally effective antithyroid medications experiencing frequent breakthrough hyperthyroid symptoms. Symptoms of palpitations, heat intolerance, and anxiety quickly resolve. Additionally, treatment with radioactive iodine can also be avoided given its associated risk of hypothyroidism, bone marrow suppression, and long-term potential for hyperparathyroidism. The short-term management of these treated RFA patients involve scheduled surveillance ultrasound examinations of the treated area to document tissue destruction and volume reduction. In these visits normal thyroid function is confirmed and structural changes in the thyroid gland are documented. These scheduled visits are at 1, 3, 6 and 12 months after treatment. Huge thyroid nodules are also effectively treated with this regimen. Nodule volume reduction leads to symptom resolution. Large nodules well above 50 ml in size will shrink by over 50% in three months and generally over 80% in 6 months. These patients notice dramatic improvement in their ability to breath, swallow, and sleep in ways they never imagined. This is all achievable with a procedure performed under a local anesthetic block. Conditions which disqualify patients include cancer, pregnancy, pacemaker, indeterminant lesions, and inability to undergo a local anesthetic block. Prior thyroid surgery with nerve injury is also a relative contraindication. Statistics on outcomes for these procedures have documented complication rates which are one tenth of surgery complication rate. Thermal Ablation of thyroid nodules is a paradigm shift in the management of structural thyroid conditions, not associated with neoplastic disease. The cost savings to the healthcare system will be realized by 1. avoiding hospital expenses, 2. avoiding lifelong medications for hypothyroidism, and 3. avoiding costs for complications incurred with surgery. With a capable provider, nodule ablation is now performed as an office-based procedure with amazing efficacy. Patient demand and satisfaction has been extremely high. Bibliography 1. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. https://doi.org/10.1089/thy.2015.0020. PMID: 26462967; PMCID: PMC4739132 2. Nishino, M., & Nikiforova, M. (2018). Update on Molecular Testing for Cytologically Indeterminate Thyroid Nodules. Archives of pathology & laboratory medicine, 142(4), 446–457. https://doi.org/10.5858/arpa.2017-0174-RA 3. Patel, K. N., Yip, L., Lubitz, C. C., Grubbs, E. G., Miller, B. S., Shen, W., Angelos, P., Chen, H., Doherty, G. M., Fahey, T. J., 3rd, Kebebew, E., Livolsi, V. A., Perrier, N. D., Sipos, J. A., Sosa, J. A., Steward, D., Tufano, R. P., McHenry, C. R., & Carty, S. E. (2020). The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Annals of surgery, 271(3), e21–e93. https://doi.org/10.1097/SLA.0000000000003580 4. Zhang J, Liu BJ, Xu HX, Xu JM, Zhang YF, Liu C, Wu J, Sun LP, Guo LH, Liu LN, Xu XH, Qu S. Prospective validation of an ultrasound-based thyroid imaging reporting and data system (TI-RADS) on 3980 thyroid nodules. Int J Clin Exp Med. 2015 Apr 15;8(4):5911-7. PMID: 26131184; PMCID: PMC4484032. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484032/ 5. Adam, M. A., Thomas, S., Youngwirth, L., Hyslop, T., Reed, S. D., Scheri, R. P., Roman, S. A., & Sosa, J. A. (2017). Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?. Annals of surgery, 265(2), 402–407. https://doi.org/10.1097/SLA.0000000000001688

The American Thyroid Association Statement on Ablation Techniques for Benign Thyroid Nodules recently published a thorough article that outlines implementation, qualification, methodology, and protocols for optimizing safety for the introduction of thermal ablation in clinical practice. This is an essential reference for all physicians hoping to embark upon interventional thyroid procedures. The endorsement of the American Association of Endocrine Surgery, American Academy of Otolaryngology, Head and Neck Surgery, American Head and Neck Society, Society of Interventional Radiology, Latin-American Thyroid Society, Asia and Oceania Thyroid Association, and Asia Pacific Society of Thyroid Surgery indicate the intense scrutiny assigned to this important reference and the broad scope of subspecialties it affects. The collective effort addresses nuances, highlighting the complexity of care associated with thyroid nodule management. The article clearly demonstrates the considerations and complexities of patient evaluation, pre-procedural planning, patient treatment, and post-procedural management. This enthusiastic effort is presented in the interest for our patients whom have experienced overwhelmingly positive results with this treatment modality. The full article is available for download.

Dr. Richard Harding is an expert in thyroid care, with 28 years of experience in evaluating and removing hundreds of thyroid glands per year. He is proud to offer RFA as a safe and effective option for his patients with benign thyroid nodules. RFA, or Radiofrequency ablation, is a non-surgical treatment that can transform the lives of people with large benign thyroid nodules. It uses internal energy to target and destroy the unwanted tissue, while preserving the healthy outer thyroid gland and its function. Success Stories RFA has many advantages over conventional surgery or RAI, such as lower risk of primary hypothyroidism (low thyroid hormone), faster recovery, and no scarring. Testimonials Our patients are very happy with the results of the RFA procedure, which allows them to avoid thyroid surgery and its complications. They can go home right after the treatment and resume their normal activities. Read More

The treatment of these thyroid nodules varies on the nature of the nodules as well as the symptoms produced. Any malignancy will need to be removed if it is over 15 mm. Some smaller malignancies are now being followed without surgery. These are followed utilizing strict criteria and under research-based protocols. The success of this non-operative surveillance of small cancers has been very successful. Small nodules tend not to create symptoms, whereas large nodules can create many problems such as difficulty with breathing when laying flat, difficulty with swallowing solid food (pills), and even a chronic cough. Nodules with compression symptoms can be removed with surgery. If they are not cancer and not suspicious for the possibility of cancer, than a minimally invasive, ultrasound guided therapy can effectively destroy the nodule. This treatment applies energy directly to heat it up to the point of tissue death. Once the tissue is devitalized, the body walls off and slowly reabsorbs the treated tissue. This method leaves the adjacent normal tissue unharmed and thus preserves the thyroid function. Unfortunately, with surgery the entire side (lobe) is generally removed due to safety concerns. This unavoidably removes the abnormal and normal tissue on the entire side. Approximately 60-75% of these patients will require thyroid hormone supplementation. If a biopsy raises a concern for the possibility of cancer, then surgery is recommended to allow for proper analysis of the tissue by pathologist. The surgery should be performed by a surgeon very familiar with thyroid operations, and who performs them regularly. The definition of a high- volume thyroid surgeon is currently established at 25 operations annually. The Thyroid Nodule Treatment Center is available to navigate the numerous diagnostic and therapeutic options with you. Patients with normal thyroid function and who are symptomatic from large thyroid nodules can present immediately to review treatment options. This includes large visible nodules which are cosmetically distracting. The most innovative therapy may be available to you. International studies demonstrate excellent immediate and long- term results with radiofrequency ablation. A list of expert endocrinologists will be provided for those patients who have a complex endocrine history and require further evaluation, and long term care.