- Before the procedure, a blood count, clotting tests and thyroid function are requested, in addition to the two benign biopsies.
- Anticoagulants and antiplatelets are paused in advance, always under medical instruction: aspirin and clopidogrel a week or more, warfarin a few days.
- A pacemaker and pregnancy contraindicate the usual electrode, and it helps to mention them at the first consultation.
Ablation is performed under local anesthesia and without an incision, and it is still a procedure on the neck, close to vessels and nerves. Good preparation is what allows it to be carried out calmly. This is the list, with what the guidelines say and what you are asked for at the consultation.
Which documents to bring to the first consultation
- 01The most recent ultrasoundWith the report and, if possible, the images. If you have an earlier one, that too: comparing volumes tells whether the nodule is growing.
- 02Any biopsies you haveThe full report, with the Bethesda category and the type of needle. Two matching benign ones are needed, and if you already have one, it is assessed whether it can count as the first.
- 03Thyroid blood testsTSH and free T4, and anti-TPO antibodies if they were done. They indicate how the gland is working and the risk of it not compensating afterwards.
- 04The list of medicationsAll of them, with doses, including over-the-counter ones and aspirin. It is the detail most often left out, and it carries real weight in the preparation.
The blood tests that are always requested
In practice a cardiology check is added when age or history advise it. If you live abroad, those tests are performed the day after you arrive, at the same hospital where the procedure takes place. If you do not have them, their cost is given to you in advance and in writing.
The medications that are paused, and when
The procedure enters a highly vascular organ with an electrode, and that is why clotting matters most. Medications that slow blood clotting, such as warfarin or heparin. and Medications that keep platelets from clumping, such as aspirin or clopidogrel. are adjusted days in advance, always under the instruction of the doctor who prescribed them and of Dr. Jacobo, rather than on your own.
- Aspirin and clopidogrel: stopped 7 to 10 days before, according to the guideline.
- Warfarin: 3 to 5 days before, with clotting checks.
- Heparin: 4 to 6 hours before.
- Other regular medications, including levothyroxine, are continued unless you are told otherwise.
What to mention from the start
Two circumstances change the plan and are worth mentioning in the first conversation, even if they seem unrelated. A pacemaker: the usual electrode is monopolar and is contraindicated, and another technique is considered. And a pregnancy, or the possibility of one: the procedure is postponed.
- Kim JH et al. 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology. Korean J Radiol. 2018, 19(4): 632-655.
