Drs Kaniksha Desai and Samer Nakhle discuss microwave ablation vs radiofrequency ablation for treating thyroid nodules.
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-- TRANSCRIPT --
Kaniksha Desai, MD: Welcome to the Thyroid Stimulating Podcast. This podcast was created in partnership with the American Thyroid Association to discuss up-to-date diagnosis and management of a wide array of thyroid diseases.

Today's episode shines a spotlight on microwave ablation, a revolutionary approach to treating thyroid nodules. This minimally invasive procedure has garnered significant attention in the medical community for its effectiveness, its efficiency, and its promising outcomes for patients with thyroid nodules.

We're thrilled to have an esteemed guest with us today, Dr Samer Nakhle, joining us from Las Vegas. He is the medical director of Palm Medical Group and the Endocrinology Fellowship program director of Sunrise Health in Las Vegas.

He is at the forefront of employing innovative treatments for thyroid conditions and has a wealth of experience in using thermal ablation procedures, including both microwave ablation and radiofrequency ablation, to treat thyroid nodules.

Throughout this episode, we'll dive into what microwave ablation entails, its mechanism, and why it stands out as the preferred method of managing thyroid nodules. We'll hear firsthand from Dr Nakhle about his experience and insights into the procedure, the science behind it, and what patients can expect during and after treatment.

Samer Nakhle, MD: Thank you. I'm Dr Nakhle.

Desai: Can you explain to us what microwave ablation is and how it works to shrink thyroid nodules?

Nakhle: Microwave ablation works on the idea of thermal ablation. Since 2000, we started thinking about using heat as a method to cause tissue death and eliminate nodules as cancer treatment. There is a microwave generator that can get the microwave to the tissue in the tip of the needle. The tip generates an electromagnetic wave.

The electromagnetic wave causes water oscillation in the tissue, leading to cellular damage using heat. The oscillation generates heat and friction, generating a temperature of about 60 °C or 140 °F in the tissue around it. That's the principle of it.

Wherever we put the needle, we can generate uniform heat spread from the tip of the needle into the tissue which causes tissue damage and necrosis.

Desai: Where was the procedure invented?

Nakhle: The first publication about thyroid nodule treatment with the microwave was in 2005.

Right now, there are about four companies, including three from China and one from Italy, that make those generators. The generator used to be a very big machine, but now, it's portable. We can take it around. The generator generates microwaves, and the idea is to transfer those waves to the needle and the needle tip releases it in the tissue wherever you put it in.

Desai: How long have you been doing this procedure personally?

Nakhle: We're going on year 2.

Desai: How effective is it in reducing symptoms associated with thyroid nodules?

Nakhle: The microwave generates the heat. When we started doing microwave ablation and looked at the old data, the studies were always about nodule shrinkage and how much of the nodule could be eliminated. We have enough data from publications over the past 15 years that showed that after 1 year, the nodules shrink about 90%.

We have enough data from other thermal ablation showing that if you're able to shrink the nodules by 50%, you get rid of the symptoms. So 50% is enough to eliminate any compressive symptom of the nodules, but with the microwaves and also personal experience, how much can you move the needle and how much tissue can you eliminate? We can eliminate up to 90%, on average, after 1 year.

By eliminating 50%, you can get rid of the symptoms. If we look at the data, all studies showed 95% symptom relief at 3 months.

Desai: It works pretty fast overall. It's not as fast as surgery, which would be immediate, but pretty fast in the first couple of months. Are there any risks or potential complications associated with microwave ablation?

Nakhle: Let's talk about the technique and the idea. We put the needle in the tissue that we want to eliminate, and the microwave can spread through that tissue. The microwave principle is that if you can leave the needle in the same spot, it will generate heat very fast and continue to spread until you stop it or you move the needle to a different spot.

Transcript in its entirety can be found by clicking here:
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