Doctors at Princess Royal University Hospital, part of King’s College Hospital NHS Trust, London are using a pioneering technique to treat benign thyroid nodules. Microwave ablation is a minimally invasive procedure that can be performed under local anaesthetic and does not leave a scar on the neck. Interventional radiologist, Dr Tim Yusuf, is the first doctor to perform this procedure in the UK. We recently asked him more about it and what it could mean for patients in the future:

What is microwave ablation?

Microwave ablation is a technique used to generate heat within structure to destroy cells via a probe placed through the skin. In the case of the thyroid, this means using that heat energy to burn nodules that are symptomatic in order to reduce their size. It is well established in other parts of the body where it is used to treat cancer, but has been more recently used for the thyroid where the intention is to treat the non-cancerous but symptomatic nodules.

Is it a brand new technique?

Microwave ablation as a technique has existed for some time, but has only been used more recently in the thyroid. Whilst we were the first to do it in the UK following approval by NICE, it has been done in other countries and the safety and effectiveness has been well established. Before a technique called radiofrequency ablation was more commonly known about and is also a form of heat ablation. Microwave represents an alternative that we feel offers some benefits over radiofrequency ablation. We have been seeing fantastic results with our early patients after a few months and patients have been very happy with the procedure itself as well as the results.

What are the benefits of this procedure over surgery?

The major benefit of microwave ablation is a smaller procedure performed through an incision around 1cm in size. It also is performed as a day case procedure under local anaesthetic with the patient awake and is usually approximately half an hour long. The patient is also able to go home within a few hours as opposed to staying overnight. As it is so minimally invasive patients can return to normal activities quickly and avoid a hospital stay. The risks of nerve injury, long term thyroid replacement therapy and scarring are all substantially less than surgery.  

Are there any risks associated with it?

As with any procedure there are risks associated, and it is difficult to entirely remove them with a number of the risks the same as for surgery but occurring less frequently. These include; bleeding, infection and of a need for emergency surgery including removal of the thyroid, voice change, skin burns, decreased thyroid function or nodule rupture. In some cases the nodules can regrow but results have suggested this is after a long time if it were to occur. The likelihood of these risks are low.

Which patients might be suitable for this procedure?

Patients who have symptomatic thyroid nodules over 2cm (but not extending into the chest) and are able to lie flat can be considered for the procedure. Single nodules can be treated in a single sessions whilst some patients with multinodular goitres may require a few sittings over a period to treat as fully as possible. Some patients may still be more suited to surgery rather than ablation and decision is made jointly with the surgical and endocrine teams.

Are there any plans to roll this out more widely on the NHS?

It is too early to tell yet and it would depend on local commissioning. Certainly, with suitable clinical willingness and skills I can see it being performed more widely in the UK at some stage in the future.

How can people find out more?

A starting point is the NICE guidance. We also have information leaflets we offer to patients prior to procedures and will be aiming to release our results after we have collected a suitable number. To find out more prospective patients can contact the Princess Royal University Hospital and ask for the interventional radiology department on 01689 863000.

Read about less invasive treatment options for thyroid nodules