A non-invasive, scar-free way to treat thyroid nodules

Assistant Professor Ngiam Kee Yuan from NUH said that based on five-year data from Singapore and Hong Kong, the procedure usually reduces thyroid lumps by 50 to 60 per cent after the first treatment. ST PHOTO: ONG WEE KIAT
Assistant Professor Ngiam Kee Yuan from NUH said that based on five-year data from Singapore and Hong Kong, the procedure usually reduces thyroid lumps by 50 to 60 per cent after the first treatment. ST PHOTO: ONG WEE KIAT

13 patients here have undergone ultrasound procedure since 2017; only one had regrowth

Relatively painless and fuss-free, an ultrasound procedure removed a non-cancerous thyroid lump in Madam Liam Lay Kwan's neck in 45 minutes.

Immediately after the day procedure, she was up and ready to go home.

The high-intensity focused ultrasound procedure, which Madam Liam underwent in June last year at National University Hospital (NUH), is a non-invasive alternative to surgery for patients with non-cancerous thyroid nodules with a diameter of between 1.5cm and 4cm.

Unlike surgery, the thyroid does not have to be removed, obviating the need for lifelong hormone medication, said Assistant Professor Ngiam Kee Yuan from NUH, adding that the procedure also does not cause scarring.

The procedure uses focused ultrasound energy to thermally destroy abnormal thyroid tissues and shrink the nodules after treatment, with the final reduced size noticeable after six months.

Thyroid nodules are abnormal growths that form lumps in the thyroid gland, which is located below the Adam's apple.

Thyroid lumps affect between 4 per cent and 7 per cent of the population, with women four times more likely than men to suffer it.

While most lumps are not malignant, some become large and cause compressive symptoms, discomfort and may be unsightly.

COMPUTER-CONTROLLED

The difference between this procedure and radio-frequency ablation - which involves inserting a needle into the thyroid - is that it is non-invasive and computer-controlled, so it can remove odd-shaped thyroid lumps and avoid critical structures in the neck.

ASSISTANT PROFESSOR NGIAM KEE YUAN, on the ultrasound procedure.

NUH was the first hospital in South-east Asia to offer the high-intensity focused ultrasound in 2017. So far, 13 patients have gone through the procedure in Singapore and only one experienced a regrowth of the nodule, said Prof Ngiam, a senior consultant in the hospital's Division of General Surgery (Thyroid and Endocrine Surgery).

An NUH study of 10 patients, who had the procedure during a 12-month period from July 2017, found the mean maximum diameter of the nodule shrank from 2.6cm to 1.4cm six months after treatment.

Only two patients experienced early, temporary voice hoarseness after treatment and none had any local skin burns or haematomas.

Prof Ngiam said that based on five-year data from Singapore and Hong Kong, the procedure usually reduces thyroid lumps by 50 to 60 per cent after the first treatment. But 10-year data on whether the lumps regrow is still lacking.

"Almost all the patients that we've offered this procedure to have previously been diagnosed with thyroid lumps, and they've been putting off surgery because they don't want to go under the knife," he added.

 
 

"The difference between this procedure and radio-frequency ablation - which involves inserting a needle into the thyroid - is that it is non-invasive and computer-controlled, so it can remove odd-shaped thyroid lumps and avoid critical structures in the neck."

But high-intensity focused ultrasound is unsuitable for patients who have previously had thyroid surgery or have scars in the front of the neck, because the scar tissue concentrates the ultrasound energy and can cause burns.

The procedure costs $7,000 after subsidy, while the cost of keyhole or open surgery ranges between $3,000 and $7,000, depending on whether half or the whole thyroid is removed.

For Madam Liam, 57, the lack of scarring was the main attraction.

"My skin isn't very good, so I was worried that normal surgery would give me a keloid scar, and the recovery for this procedure was very fast," said the finance and administrative executive.

A version of this article appeared in the print edition of The Straits Times on July 19, 2019, with the headline 'A non-invasive, scar-free way to treat thyroid nodules'. Print Edition | Subscribe