Dr Monica Negrean is a highly qualified and dedicated specialist in endocrinology and diabetology at the renowned Cellitinnen-Krankenhaus St. Vinzenz in Cologne. Born and raised in Cluj-Napoca, Romania, Dr Negrean developed a passion for medicine at an early age, which has stayed with her throughout her life. She completed her medical studies at the University of Cluj-Napoca, where she began to explore the importance of nutrition for health in depth during her initial specialist training. After completing her specialist training, Dr Negrean moved to Germany to continue her medical career.
In her doctoral thesis, she investigated the influence of nutrition on vascular health in diabetes patients and, through a second specialist training in endocrinology, gained an in-depth understanding of hormonal and metabolic processes in the human body. Dr Negrean’s main areas of treatment in diabetology include the interdisciplinary management of diabetic foot syndrome, including the assessment of suspected circulatory disorders and Charcot arthropathy. In endocrinology, her focus is on the treatment of thyroid disorders, including fine-needle aspiration of nodules and radiofrequency ablation of benign thyroid nodules. She has particular expertise in the diagnosis and treatment of disorders of the pituitary gland, thyroid, parathyroid glands and adrenal glands, as well as in the assessment and management of obesity. Hormone deficiency during the menopause or in men is also within her area of expertise.
Today, Dr Negrean is Head of the Department of Diabetology and Endocrinology at the Cellitinnen-Krankenhaus St. Vinzenz in Cologne-Nippes, one of the leading institutions of its kind in Germany. The clinic treats around 1,300 inpatients annually and places a particular emphasis on the treatment of diabetic foot syndrome and other chronic wounds in order to avoid unnecessary amputations. As the West German Center for Thermoablation, the clinic has been at the forefront of minimally invasive treatment for thyroid nodules since 2015.
Dr Negrean is not only active in clinical practice but is also deeply committed to training young doctors. She passes on her extensive knowledge and experience to the next generation of doctors and is held in high regard and gratitude by her patients. Through her dedication and expertise, Dr Negrean makes a significant contribution to the high quality of patient care and ensures that the clinic at St. Vinzenz Hospital continues to play a leading role in the treatment of endocrinological and diabetological conditions. The thyroid gland causes problems for many people and can also lead to significant weight fluctuations.
The editorial team of the Leading Medicine Guide spoke to Dr Negrean specifically about radiofrequency ablation of thyroid nodules.
The thyroid gland, a small butterfly-shaped organ located at the front of the neck, plays a crucial role in the human body. It produces vital hormones that regulate metabolism, growth and development. Despite its small size, the thyroid gland has far-reaching effects on almost all organ systems and plays a vital role in maintaining health. Disorders of thyroid function can cause a wide range of often serious health problems, which is why a basic understanding of its function and potential diseases is of great importance. Nodules in the thyroid are areas of thickened thyroid tissue that can arise from a variety of factors. These nodules can be either benign or malignant, although most are benign.
The causes of nodules in the thyroid are varied and include a range of factors.
“When it comes to the thyroid, we are essentially dealing with two major conditions. The first is thyroid dysfunction, which includes hyperthyroidism and hypothyroidism. The second group of conditions involves structural changes, with nodule formation being by far the most common change, the main cause being iodine deficiency. Women are affected more frequently than men, and the risk increases with age. In Germany, one in four people – that is, 25 per cent of the population – have nodules in the thyroid; among older people, it is one in two to one in three,” explains Dr Negrean at the start of our conversation.
Genetic predispositions also play a role, as a family history increases the risk of developing thyroid nodules. Chronic inflammation of the thyroid, such as that seen in autoimmune diseases, can also lead to nodules. In addition, benign tumors, known as adenomas, can present as nodules, and in rare cases, thyroid cancer may be the cause. Cyst formation and fibrosis resulting from chronic inflammation or tissue damage can also cause nodules.
The symptoms of thyroid nodules can be varied and depend on the size, location and function of the nodules. Small nodules often remain asymptomatic and are discovered by chance during routine examinations. However, if symptoms do occur, they may prompt the patient to consult a doctor.
“Nodules are often discovered incidentally during an ultrasound scan of the thyroid. However, it is also possible for a patient to feel or even see a nodule themselves. Patients may also experience a feeling of pressure or tightness in the neck. This is noticeable when swallowing, and in more severe cases also when breathing, or one may notice that, for example, the collar of a shirt no longer fits. Larger nodules can cause hoarseness by pressing on the vocal cord nerves,” says Dr Negrean regarding the symptoms of thyroid nodules, before explaining the diagnostic procedure:
“The investigation of thyroid nodules takes place in several stages. First, we talk to the patient (medical history), who tells us their story, and we then carry out a physical examination, during which we palpate the neck for swelling and nodules. An ultrasound scan is usually carried out to determine the size, texture and exact location of the nodules and to examine the lymph nodes. This method provides a detailed view of the thyroid gland and helps to determine whether the nodule is solid or cystic. A biopsy may be performed for further investigation. This involves using a fine needle to remove cells from the lump and examining them under a microscope for cancer cells. Blood tests to measure thyroid hormone levels and other relevant parameters, such as thyroid-stimulating hormone (TSH), are also carried out to assess the function of the thyroid gland. In some cases, a scintigraphy, a nuclear medicine examination, may be helpful in assessing the activity of thyroid nodules and distinguishing between cold (non-hormone-producing) and hot (hormone-producing) nodules.
Radiofrequency ablation (RFA) offers specific advantages over conventional surgery in the treatment of benign thyroid nodules.
“Radiofrequency ablation has been used on other organs for many decades. In the treatment of the thyroid, the method has been used internationally for over 20 years and is based on the principle of destroying the nodule using heat. During ablation, a probe is inserted into the nodule and heated. The heat destroys the nodule, which is then gradually broken down by the body, much like a bruise that fades away over time. This leads to a significant reduction in size over several months. Personally, I do not see radiofrequency ablation as a competitor to surgery, but rather as a complement to it. Then there are specific types of nodules, namely autonomous adenomas, which produce too many hormones. In these cases, radioiodine therapy is the treatment of choice. However, there are also patients who reject this form of treatment, for example women planning a pregnancy, because the word ‘radioactive’ has negative connotations. In such cases, radiofrequency ablation is a good alternative. Or the nodules are removed surgically. When it comes to thyroid surgery, Germany is at the forefront internationally. In my opinion, not all operations are always necessary,” explains Dr Negrean, adding:
“A key advantage is the minimally invasive nature of radiofrequency ablation, which usually only needs to be performed once. As it is carried out under local anesthesia using a thin needle, large incisions and the associated scarring are avoided. Furthermore, the risk of complications such as infections, bleeding and damage to surrounding structures, for example the vocal cord nerves, is lower than with traditional surgery. Before the procedure under local anesthetic, patients are also given a small sedative tablet and remain awake. The treatment is relatively painless or often pain-free, as the thyroid gland has no pain receptors – the surrounding tissue is numbed. Patients recover more quickly after an RFA and only stay in hospital for 1–2 days. They usually resume their normal activities within a few days and experience only minimal time off work. Another important advantage of RFA is the preservation of thyroid function. As RFA treats only the nodule and the surrounding thyroid tissue is largely preserved, the likelihood of impaired thyroid function is lower. Follow-up care includes regular ultrasound and laboratory tests to monitor the regression of the nodule and thyroid function.
For a patient to be eligible for radiofrequency ablation (RFA), certain criteria must be met to ensure that this procedure is both safe and effective.
“Before radiofrequency ablation is performed, it must be confirmed that the nodule is benign. This is because, in the case of malignant nodules, one cannot be certain that radiofrequency ablation will destroy all the malignant cells. Even if the nodules are located very low down, such as below the collarbone, RFA is problematic because the risk of complications is too high. Patients with severe coagulation disorders or those taking blood thinners must be assessed with particular care, as the risk of bleeding may be increased. The patient should be in good general health and have no serious underlying conditions that could increase the risk of the procedure. However, there are specific contraindications for RFA that must be taken into account. Patients with malignant thyroid nodules or suspected thyroid cancer are not suitable for RFA and usually require surgical treatment. Patients with active infections in the neck or head area are also unsuitable, as this increases the risk of complications. Patients with pacemakers or other implanted electronic devices should also be thoroughly examined before the procedure. The treatment is also not performed on pregnant women,” explains Dr Negrean.
Radiofrequency ablation is a relatively safe procedure. Nevertheless, complications can occur.
“In rare cases, a bruise (hematoma) may develop at the puncture site, but this usually heals on its own. Another possible complication is an infection at the puncture site. It is extremely rare for the vocal cord nerves to be affected, as we take care to spare these structures. The risk of permanent underactive thyroid (hypothyroidism) is low, but can occur with extensive treatment. Compared to traditional surgical procedures, the complications of RFA are usually less severe and occur less frequently. “Surgical procedures may be associated with a higher risk of permanent thyroid dysfunction, injury to the vocal cord nerves, larger scars and longer recovery times,” explains Dr Negrean.
Studies have shown that most patients do not experience significant changes in their thyroid hormone levels following RFA, and their thyroid function remains normal. However, further well-controlled studies involving larger patient groups over a longer period are required for a more comprehensive assessment of the long-term effects of RFA.
Outlook for the future and advice on thyroid care
“In medicine, knowledge doubles at least every two years. Radiofrequency ablation has been available in Germany as a thyroid treatment for around 12 years. Guidelines are already in place and there is a wealth of experience. The technical possibilities, including those relating to the planning of procedures, will certainly continue to develop in this area. But we are already very satisfied with what we have in this field. If I may offer a piece of advice: Germany used to be an area with iodine deficiency and is now once again a country with mild iodine deficiency. In our grandparents’ generation, there were often these huge goitres. We no longer have those today because we have improved iodine intake. In that respect, the use of iodised salt definitely makes sense to support this intake. However, in cases of hyperthyroidism, iodine-enriched salt intake is counterproductive; but for the general population, iodine-enriched salt is beneficial! For this reason, all pregnant women are also given additional iodine,” explains Dr Negrean, bringing our conversation to a close.
Thank you very much, Dr Negrean, for this helpful information on the treatment of thyroid nodules!
