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
Dr. Noel completed her undergraduate work in Biochemistry/Cell Biology and Economics at the University of California in San Diego. She remained at UCSD for medical school, then relocated to Stanford University, where she completed her residency in Otolaryngology Head & Neck Surgery. She then pursued a fellowship in Endocrine Head & Neck Surgery at Stanford. She specializes in surgery of the thyroid and parathyroid glands, lymph node dissections, and has additional expertise and interest in advanced and recurrent thyroid cancer, minimally invasive approaches, and ultrasound guided techniques in the office.
✅ TWITTER @JuliaNoelMD
✅ WEBSITE https://profiles.stanford.edu/julia-noel
✅ WEBSITE https://rfamd.com/julia-noel/
View Full Profile: Dr. Julia Noel
About Philip James
In 2013, his 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 him speak.
The word he uses to describe his work as patient advocate is, ‘tonglen’. Or, using his pain and hardship to help others.
