In Italy, more than 40,000 total thyroid asportation surgeries are performed annually, with 80% being done on women and in only 2% of cases has the healthy part of the gland been preserved.
With the #Salvalatuatiroide campaign, conceived and supported in Italy by the Association Thyroid Nodule Therapies, we aim to inform citizens that there are innovative and minimally invasive approaches to the treatment of nodular thyroid diseases.
The consequences of classic surgery can thus be avoided, in many cases, thanks to advanced technologies such as radiofrequency ablation (RFA) which is the most commonly used system. Other related technologies include microwave ablation (MWA), laser ablation (LA), and highly focused ultrasound (HIFU) ablation.
Most benign nodules, but also papillary microcarcinomas, which encompass the majority of malignant diagnoses, can now be eliminated through “thermal ablation” procedures. RFA and related methods bring about thyroid nodule destruction by heating. These outpatient procedures performed under ultrasound guidance do not require surgical incisions.
The numerous advantages of minimally invasive ultrasound-guided thermoablative procedures over the standard surgery are:
- absence of scars,
- preservation of non-nodular normal thyroid tissue,
- preservation of normal thyroid function,
- no need for thyroid hormone therapy,
- minimal side effects,
- no intubation for general anaesthesia,
- no drainage tube,
- no hospital admission,
- much faster recovery and return to daily activities.
These advantages, compared to the therapeutic results obtained by traditional surgical methods, substantially translate to a significant better quality of life for the patient.
What are thyroid nodules and what are the therapeutic options
Thyroid nodules, lesions of the thyroid gland distinct from normal tissue, are fairly common. While studies conducted in the 1970s based on inspection and palpation reported a prevalence of thyroid nodules from 3 to 7% in the total population, the recent introduction of ultrasound technology has revealed that the percentage of thyroid nodules is much higher, varying from a minimum of 20% and a maximum of 76% in the general population. Interestingly, the thyroid nodule detected through ultrasound has a prevalence like that described by autopsy studies of the 50s, that is, the number of nodules detected by ultrasound corresponds to the number detectable by examination of gland tissue.
Moreover, it has been found that patients with a palpable thyroid nodule who have undergone an ultrasound examination have a percentage of additional nodules between 20 and 48%. Thyroid nodules are more frequent in older people, women, people from iodine-poor regions, and those with a history of ionizing radiation exposure.
Furthermore, thyroid nodules are often detected during neck examinations carried out using various imaging systems such as doppler examinations of carotids, CT, MRI and PET, performed for reasons unrelated to thyroid disease.
Thus, the widespread use of imaging techniques has shown the existence of a real epidemic of nonpalpable thyroid nodules, often present at lower limits of ultrasound detection. As a result, an increasing number of asymptomatic thyroid nodules now undergo further investigation, which has led to a dramatic rise in diagnoses of thyroid tumours and papillary thyroid microcarcinomas. As a result, thyroid removal surgery has increased enormously: in 2016 about 40,000 total thyroid removal surgeries were performed in Italy, with 80% of cases in women, but in only 2% of cases was the healthy part of the gland preserved.
In the case of small malignant thyroid lesions which are generally devoid of aggression (MPTC), it is recommended not to perform any surgery but rather to monitor the patient. This concept of “active surveillance” is rejected by many patients who, once diagnosed with cancer, prefer to undergo the surgery that is offered them by most specialists who follow the standard established guidelines.
According to recent international guidelines to which the TNT Association has collaborated, the alternative to surgery and active surveillance is represented by ablative therapies that offer a solution to the problem by avoiding the partial or total removal of the gland and thus preserving the thyroid.