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November 7, 2021 25 min

Protecting the nerves during RFA and thyroid surgery with Dr. Julia Noel from Stanford Health Care.

Hosted by Philip James.

Supported by

Find an RFA doctor at 🔹🔹🔹

During this interview, the following topics are discussed:

→ Stanford University prioritizes anatomic structures, ultrasound, and how to best protect the laryngeal nerve

→ Pre- procedure ultrasound is instrumental in minimizing risk

→ Risk to the laryngeal nerve is minimal during RFA

→ Where to deliver heat is guided by ultrasound

→ If unintended consequences occurs during RFA, they are usually reversible

→ Most risk is affecting a patient’s voice

→ Technique and space — away from structures — can be controlled with extra fluid

→ Dr. Noel has conducted 80+ RFA procedures at Stanford University

→ What should every practitioner know in regard to protecting the nerves?

→ Commitment to ultrasound anatomy is critical

→ Ultrasound guided procedures

→ The Stanford RFA team for conducting a procedure is one assistant MD or Fellow, medical assistant laying out equipment and vital signs

→ Patient due diligence when selecting an RFA doctor is key: it should include vetting providers for their experience with RFA → Ask if the doctor has done RFA procedures, what’s the plan for follow up?

→ With RFA, are fewer thyroidectomies occurring?With RFA in clinic, patients now have more treatment options → “No hammers looking for nails”

→ Who is the ideal candidate for RFA?

→ Solitary, large, benign thyroid nodule is the ideal candidate → Cost is between $5000 - $10,000

→ Reduction in thyroid nodule size is up to 80%

→ RFA can be used for malignant nodules

→ Why did it take so long for the U.S. to adopt RFA?

FDA processes are laborious and time consuming

→ Is RFA painful? Generally “no”

→ RFA fills a void in treatment options for thyroid nodule

→ Preservation of thyroid function is key — the thyroid is preserved

→ Does insurance cover RFA treatment?

→ Sometimes the insurance company will cover the procedure through an appeal process

About Dr. Julia Noel

✅ TWITTER @JuliaNoelMD



✅ Grand Rounds Video on YouTube

✅ About Philip James

✅ Instagram @philipjames360

✅ TWITTER @docthyroid

✅ LinkedIn @Philip James

✅ Website

✅ YouTube


✅ ABOUT Philip James

I shared my story with many of you on my podcast: Doctor Thyroid In 2013, my laryngeal nerve was severed, shoulder nerve damaged, parathyroids ruined, and residual cancer left behind — all for a 1 cm thyroid nodule.Later, a vocal cord implant was inserted to help me speak. The bad result of thyroid surgery dampened my quality of life → and left me wondering, what exactly happened → during what should be a low-risk surgery? My attempts to follow up with UCLA and the surgeon were ignored. So, I turned to other doctors for answers — this was the beginning of the podcast: "Doctor Thyroid with Philip James" 100+ episodes later, the Doctor Thyroid podcast is popular amongst patients; allowing them access to information from top doctors, without being limited by geography or economics. The word I use to describe my work as patient advocate is, ‘tonglen’. Or, using my pain and hardship to help others. When not producing podcast episodes or co-hosting live Q&As for patients with top doctors, I lead the creative team at Philip James Media — we are a marketing agency dedicated to digital communications — serving the sectors of healthcare, payments, and Greentech. The Doctor Thyroid podcast is available in Spanish and English - and listened to in over 30 countries: (Spanish) (English) Please email your requests to 🔹🔹🔹

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