A MODERN APPROACH TO THYROID NODULE MANAGEMENT

Insights from Dr. Angela Mazza

In recent years, thyroid nodules have become an increasingly common clinical finding, often detected incidentally during imaging for unrelated conditions. Dr. Angela Mazza, a board-certified endocrinologist and founder of the Metabolic Center for Wellness, has dedicated much of her integrative endocrinology practice to understanding and managing thyroid nodules using the latest technologies and non-surgical interventions.

The Prevalence and Nature of Thyroid Nodules
Thyroid nodules, which are masses located within the thyroid gland itself, are remarkably prevalent. “If we ultrasound everyone walking down the street,” Dr. Mazza notes, “one in three people will have some sort of nodule.” Fortunately, the vast majority are benign and asymptomatic. Ultrasound imaging has become the frontline tool in classifying nodules based on characteristics such as size, echogenicity, vascularity, and the presence of microcalcifications — all features that help clinicians stratify risk and determine the need for biopsy or intervention.

Particularly common in patients with autoimmune thyroid conditions like Hashimoto’s thyroiditis, nodules can range from true growths to pseudo-nodules — regions of altered tissue responding to autoimmune activity. “I’d estimate that more than 50% of my Hashimoto’s patients have some form of abnormality, whether it’s small, inconsequential, or something more concerning,” Dr. Mazza explains.

Understanding the Causes and Risks
For decades, iodine deficiency or excess was blamed for most thyroid nodule development. However, Dr. Mazza emphasizes that current research points to multiple contributing factors. “Inflammation plays a big role. Obesity, estrogen dominance, and even certain infections like H. pylori have been implicated.” While viruses such as Epstein-Barr have been studied, causality remains unconfirmed.

A subset of nodules, known as toxic nodules, function independently of the thyroid’s regulatory mechanisms, leading to localized overproduction of thyroid hormone and hyperthyroid symptoms. Historically, these were identified via radioactive iodine uptake scans, but Dr. Mazza now relies exclusively on ultrasound and lab testing for diagnosis, noting the inefficiency and radiation exposure of the older method.

Diagnostic and Molecular Advances
When nodules present features such as irregular borders, rapid growth, or microcalcifications, ultrasound-guided fine-needle aspiration (FNA) biopsy is the gold standard for assessment. These procedures, particularly when performed by experienced specialists, yield a sensitivity and specificity approaching 98-99%.

Dr. Mazza also stresses the importance of molecular testing for indeterminate cases. “If biopsy results aren’t clearly benign or malignant, we can analyze gene mutations associated with thyroid cancer to better predict future risk,” she explains. This stratification can guide decisions on surveillance versus intervention and has significantly improved management pathways.

Radiofrequency Ablation: A Game-Changing Treatment
Among the most exciting developments in thyroid care is radiofrequency ablation (RFA). Though used globally for over two decades, it wasn’t FDA-approved in the U.S. until late 2018. RFA employs targeted electromagnetic energy to destroy thyroid nodules while preserving the surrounding gland, offering a minimally invasive alternative to surgery.

“Patients love that we can treat a problem nodule and leave their thyroid intact,” says Dr. Mazza. Performed in-office with local anesthesia, the outpatient procedure typically takes under two hours, with most patients returning to work within a day or two. Side effects are minor, limited to tenderness or transient discomfort, with rare complications like voice changes being far less frequent than with traditional surgery.

Dr. Mazza also notes RFA’s emerging role in treating small papillary thyroid cancers — the most common type of thyroid malignancy. “For select cases under 1.5 centimeters, where the cancer is slow-growing and well-positioned, RFA offers a safe, effective alternative to surgery.”

Complementary Treatments and Cautions
While RFA dominates discussions, Dr. Mazza also performs percutaneous ethanol injection (PEI) for cystic nodules — draining fluid-filled growths and instilling sterile alcohol to prevent recurrence. Other thermal ablation modalities like laser and microwave ablation exist but are currently less common in practice.

On the subject of iodine, Dr. Mazza remains cautious. While deficiency can contribute to nodule development, excess iodine, particularly from supplements, poses risks for those with autoimmune thyroid disorders. “I routinely test iodine levels before recommending supplementation. Many people already get enough iodine through diet, and more isn’t always better.”

Barriers to Adoption and Patient Advocacy
Despite clear clinical advantages, insurance coverage for RFA remains limited, as no dedicated procedural code has been approved in the U.S. “Patients are often paying out-of-pocket and submitting for reimbursement themselves,” says Dr. Mazza, who actively advocates for broader coverage and physician education. She notes that patient-driven demand is accelerating change as individuals increasingly educate their doctors about alternatives to surgery.

A Vision for Integrative, Patient-Centered Care
Dr. Mazza’s integrative approach to endocrinology blends conventional diagnostics with patient-centered, minimally invasive interventions. Her mission is to empower patients with evidence-based options that preserve quality of life. “Medicine moves slowly, but awareness is growing. Treatments like RFA are a great example of how we can modernize care while respecting patient preferences.”

For those seeking more information, Dr. Mazza invites readers to visit metaboliccenterforwellness.com and explore her published works detailing her journey into integrative endocrinology.