Angela D. Mazza, DO, FAAMFM, ECNU, CDE is double board-certified in Endocrinology, Diabetes and Metabolism and Internal Medicine. She completed her fellowship in Anti-Aging and Metabolic and Functional Medicine through the American Academy of Anti-Aging Medicine (A4M). She is also certified by the American Association of Clinical Endocrinologists (AACE) in neck ultrasounds and diagnostic biopsies, as well as being certified by the American Association of Diabetes Educators (AADE) in diabetes education. Highly regarded for her individualized approach to patient care, Dr. Mazza empowers each person to achieve their unique goals by providing education, lifestyle management and support.
Mazza’s broad medical background includes significant research in both basic and clinical realms of endocrinology. She has served as the principal investigator and sub-investigator on multiple, large-scale diabetes therapy and device trials. This expertise led to numerous publications and national and international conference presentations.
Originally from Wilmington, Del., Mazza earned a double-major in chemistry and biology from West Chester University of Pennsylvania, where she graduated Magna cum Laude. She attended medical school at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, where she graduated as a member of Psi Sigma Alpha, the National Osteopathic Scholastic Honor Society. She completed her internship and residency in Internal Medicine at Mercy Catholic Medical Center in Darby, PA before pursuing fellowship training in Endocrinology, Diabetes and Metabolism at Saint Louis University in Saint Louis, MO.
Mazza is the founder of Metabolic Center for Wellness in Oviedo, where the goal is to provide integrative endocrinology care for optimal hormonal balance.
In our most recent edition of “In Other Words,” Dr. Mazza shares an innovative technique for curing thyroid nodules without the need for surgery.
In Other Words…with Angela Mazza, DO
If you could offer a treatment option that would help your patient avoid unneeded surgery, would you still recommend surgery as the best course of action? Or, furthermore, would your patient still want to be put through surgery if not necessary? Now, there is a treatment modality for thyroid nodules that is effective and obviates the need for surgery for certain nodules.
Thyroid nodules are extremely common. About one in three persons will develop some sort of abnormality within their thyroid in their lifetime. Thyroid nodules are masses within the thyroid that are usually quite harmless and require no intervention other than possibly following with routine thyroid ultrasounds. Thyroid nodules can be cancerous, and, at present, the only option is surgical removal of part or all of the thyroid depending upon the mass size. However, some nodules can continue to grow and cause compressive or cosmetic issues, or some nodules become overactive. This is where radiofrequency ablation (RFA) is an excellent non-surgical option.
When it comes to thyroid nodules, patients often ask, regarding surgery, “why can’t the surgeon just go in and take out the nodule only?” leaving the rest of the healthy thyroid tissue intact. Although that thought process makes sense, trying to accomplish this type of operation would likely lead to complications like bleeding throughout and after surgery. This complicated procedure would likely lead to more issues than it is worth. Therefore, removal of the entire lobe of the thyroid or the whole of the thyroid is usually performed.
RFA is a minimally invasive technique that has been used for years as a common treatment for small tumors in tissues such as the liver, lung, kidney, and prostate. Its use has also been extended effectively in the treatment of heart disease and varicose veins. RFA involves the introduction of alternating electric current into a tissue by an electrode. Ionic agitation causes ionic friction, which, in turn, results in heat production. This frictional heat that is generated in the vicinity of the electrode causes immediate tissue coagulation; however, more distant tissue is ablated via conductive heat more slowly.
In 2002, RFA was first used for the treatment of enlarged benign thyroid nodules in South Korea. Since that time, RFA has been studied internationally and has proven to be a safe and effective therapy for benign thyroid nodules as well as autonomously, or “toxic” thyroid nodules. The great success of RFA around the world led to the approval of RFA in the United States for this purpose by the FDA in late 2018. There are still very few providers in the United States who offer this treatment modality.
RFA for thyroid nodules involves directing the energy of the electrode precisely into the thyroid nodule using ultrasound guidance. This allows targeting the nodule at hand and minimizing any injury to healthy thyroid tissue. RFA is performed with local anesthetic to the skin and thyroid capsule without general anesthesia that would be required for surgery. Thyroid tissue itself does not have nerves. Any procedural discomfort is minimal, and any post-procedure scarring or bleeding is almost negligible. RFA also minimizes any risk of permanent damage to the nerves of the vocal cords or to the parathyroid glands that may accompany thyroid surgery.
RFA is extremely effective, and results can be noted quite quickly. Depending on the nodule, most nodules can be decreased in size from 60-90 percent within one year. Clinical studies have demonstrated that benign, non-functioning thyroid nodules showed approximately 50-80 percent by six months and one year follow-up of about 90 percent. As far as overactive thyroid nodules, RFA decreased size about 50-70 percent at six months and brought thyroid hormone levels back to normal in most patients.
To be considered for RFA, a person must have biopsy-proven benign status. From that point, the thyroid nodule should be creating some sort of issue for the patient – whether it is cosmetically bothersome, causing compressive symptoms, or rapidly growing. Other potential candidates include persons who prefer not to or cannot undergo surgery or who have a toxic nodule. Persons who should not undergo RFA include patients with severe heart disease, patients on anticoagulation that cannot temporarily be held, and patients with a pacemaker and/or defibrillator. Pregnant patients also should not have RFA.
As with any medical procedure, there is the potential for complications. Although complications with RFA are very rare, they may include bruising or soreness, skin burn where the probe was inserted, temporary hoarseness. There is also the possibility of failing to obtain the desired results and requiring additional treatment, and, even more rarely, the possible need for thyroid hormone therapy.
As an integrative endocrinologist, one of my goals is to help my patients improve and maintain proper thyroid function. The thyroid is not a disposable gland. It is responsible for thyroid hormones that have receptors on the majority of tissues of our body. It is responsible for metabolism on all levels as well as playing a crucial role in gut regulation, cardiac and pulmonary function, skin and hair integrity, as well as mood effects, just to name a few. Even with the best thyroid hormone replacement, it is incredibly challenging to regain optimal thyroid function post-surgery. I appreciate my surgical colleagues on all levels, but they will also agree they want the best outcomes for their patients and that surgery may not always be the best option. RFA is a step in the progress of thyroid health. RFA has become an invaluable asset to treat thyroid nodules and preserve thyroid function, as well as avoid possible complications associated with thyroid surgery.
