24: Advancing Thyroid Care: Minimally Invasive Treatments with Jonathon O. Russell

Today we are tackling a game changing topic in thyroid health. How new and minimally invasive techniques are revolutionizing the treatment of thyroid nodules. We're going beyond the standard approach of thyroid surgery and instead we're exploring radio frequency ablation, or rfa, as well as scarless thyroid surgery, both of which are transforming the way that we manage thyroid conditions. To help us unpack all of this, I am honored to be joined by a true expert in this field, Dr. Jonathan Russell. He is a leading expert in cutting edge thyroid treatments, including radio frequency ablation. This man has more studies on this topic than I ever dreamed of and it's scarless thyroid surgery. Dr. Russell is the founder of the Russell center, where he specializes in providing patients with alternatives to traditional thyroid surgery, helping them avoid unnecessary scarring and potentially lifelong thyroid medication, as well as empowering them to choose the best, best specific path for their journey. His extensive experience and dedication to advancing minimally invasive thyroid care had made him the go to authority for patients seeking effective yet less aggressive treatment options. Today we're going to dive into how RFA can be used to treat a variety of thyroid nodules, including benign, cancerous and toxic, while also exploring the groundbreaking possibilities of scarless thyroid surgery. If you've ever felt stuck between wait and watch or jumping straight into surgery, this conversation is for you. Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. I am so excited to have this conversation today. Thank you so much, Dr. Jonathan Russell, for being here. We're excited to learn about what is on the horizon and the next evolution of thyroid care when it comes to nodules, cancer, all of that that really I feel like needs to evolve and you're on the forefront of that. So I'm excited to share with listeners everything that you've been working on. So thanks for being here.

Thanks, Michelle. So happy to be here and so excited. You and I had a great conversation a couple of weeks ago as you just kind of took me through your journey that got you here and it's been really fun to watch how successful you've been and how much you've been able to help people by using science in a way that kind of reaches down and makes it a little bit more personal. So bravo.

I love it. I think our journeys are certainly parallel, so I'm excited to to explore that more and more Tell me a little bit about your background, where you've come from, how you sort of ended up in this niche and even in. In the field of RFA and progressive thyroid alternative options for people.

Yeah, there's a lot of stuff going on in thyroid, which is really fun to say. Thyroid surgery has been kind of static for 120, 130 years. Theodore Coker won a Nobel Prize back in the early 1900s for making thyroid surgery safe. And it's almost like the field just stopped after that. It was like, oh, good, we have a safe surgery. We're good. And it's really started to evolve in the last decade, and it's been a great time to be a thyroid and parathyroid surgeon and just watch and help this field develop. I did my training at the Cleveland Clinic, and as I was trying to pick a specialty I really fell in love on, I was sure that I didn't want to be a surgeon because surgeons are all arrogant jerks. Right. That's the stereotype. Even as a medical student, we think that about. We think that about surgeons. And I did my surgery rotation and I fell in love with. With thyroid surgery, specifically, just because of how elegant it is and how. How the anatomy is just amazing. And there's a level of artistry that goes into it just to make it look good. It's not. It's not cosmetic surgery. It's cancer surgery most of the time, or very functional surgery, but at the same time, it has to look good. And it was just. It appealed to every, every part of me. So at the Cleveland Clinic, I. I stayed there and did my training and had neck surgery, treating all of the different head and neck cancers, and then did a focused thyroid fellowship at Johns Hopkins and stayed there for almost 10 years before leaving about six months ago to start my own practice here in Maryland.

Well, congratulations. Right? That's an exciting. That's an exciting time for you, for sure. I know that one thing that you've done a lot of research on, that you've really been a part of and foundational in, is the movement of rfa, or radio frequency ablation. And that is a topic no one really knows about on a consumer level, but even on a clinician level, like.

It'S just so true.

Yeah, it's incredibly fascinating and new, and I'm really excited to dig into a little bit about that today before we kind of head towards that aspect of the conversation. I wanted you to tell us a little bit about how you ended up pursuing RFA and how you found yourself in this situation.

So, first of all, thank you. I'm excited because you have a huge reach and it gives us a chance to get in front of patients and say, hey, if you're being told that you need surgery, let's consider all the options. Because a lot of doctors and even surgeons don't know about these options yet. And if you as the patient are empowered to come and say, hey, what about this? All of a sudden, it opens up a whole different channel. And it's so disappointing for me to meet a patient who could have had a non surgical option. And they just feel it's you. Even if you choose surgery at the end, just the ability to have options, it makes you feel better. It makes you feel like you made a choice instead of you took what you had to have. So thank you, first of all, for that. My. My own personal journey is a little bit funny on this one. My very first day at Johns Hopkins. So I. I'm doing this fellowship, right, which is an extra dedication. You finished all your training, you're a licensed doctor, you can do everything. You take an extra year at the end. And I was doing thyroid and parathyroid surgery. And my very first day, the surgeon I was with wasn't operating. He was doing a lab. And so we went down to the basement with all these big fancy MRI machines and expensive needles everywhere, and we had a live pig on the table that we were trying to ablate. And I don't know how people feel about animal testing, but it's actually kind of valuable in this situation. And by the very first day at Hopkins, we tried to treat a thyroid on a pig with a needle guided ablation. And then we. And then we looked at it to see how effective it was. And I remember just having so many feelings. First of all, this is really cool that we might be able to offer a non surgical option. And second of all, oh, my gosh, I'm a surgeon. What am I supposed to do if all of a sudden everything is, there's no more surgery? Because this works so well? And so my journey was, look, my job as a physician is to do what's best for my patients. And so I have to put my own. I love thyroid surgery, but if it's not what's best for my patients, I have to move past what's what I want. And so I thought, I just need to be at the front of this and test it out. Because if it's not right for a patient, then I want to know. And if it is right for a patient, I want to be the one offering it so that patients have choices when they talk to a doctor instead of just saying, oh, you're going to have to see somebody else. Like, if you want rfa, Yeah, I do tons of that. If you want surgery, yeah, that's most of what I do as well. And, and that way it's. It's you. You offer patients more and they have a chance to kind of choose what's going to be best for them. So. So anyways, that's the long version of, of how I got here.

I love it. And there's something to empowering the patient along their journey and allowing them to choose right. Like, that is so powerful, especially, I think, in the world of thyroid. Call me biased, but especially in the world of thyroid. And then the one other thing, There was one other thing I wanted to put a pin in in that conversation. Oh. And it's. Thyroid is still patient driven. Like, it's. Patients can't sit back and just be like, okay, well, my doctor says this is what I have to do and this is what I have to do. In the world of managing your thyroid, getting diagnosed with a thyroid condition, but also with surgery, I, I have this discussion with people quite often of if you have to have your thyroid removed, you have to have it removed. There's a lot of times people don't have to, but I've had patients be offered a thyroidectomy for inability to manage their hormones, like, difficulty giving them proper doses of medication for just for Hashimoto's, just being like, well, let's just do it. Let's take it out, you know, and like, listen, it is there for an option and some people really, really need it, but it's not the only option. So I'm excited to explore this.

I had a patient this morning who came in and said, yeah, my mom, my aunt, both had thyroidectomy for Hashimoto's. And so I'm here to set up my surgery. And I'm like, hold on, why are we doing surgery? Like, do you have a nodule? Do you have cancer? Well, no, I have Hashimoto's. Isn't that what you do?

No, no, you don't.

You need to. Like, what's your reason?

So, yeah, yeah, I couldn't agree more. And. And life is not always easy post thyroidectomy. It can be really challenging from a quality of life standpoint. So it's important that people have options. And this conversation, I think, will facilitate that to a high degree. So obviously, people listening, they probably have no idea what RFA is, so I'd love for you to take us through what it is, the basics of it, in an easy, understandable way.

So radiofrequency ablation is something that we've used for actually a long time, for decades and decades and other parts of the body for treating tumors that exist. It's most commonly used in the liver, like if you have metastatic cancer to the liver. And in that situation, it's a very straightforward and easy treatment with almost no recovery that can shrink tumors. And we've used it in other parts of the body so long that we kind of know that it's very safe. But we haven't used it very much in the thyroid. And the reason we haven't used it much in the thyroid is because the anatomy is very compact. Up in your neck, there's not a lot of extra space in your liver. It's a big organ. You've got space to operate around. But what we do with radiofrequency ablation, and why it's more effective now is we've learned how to protect the surrounding structures so that we can use a needle and put it right into the middle of the tumor, or the nodule, usually is what it would be. And then we treat that area, and we kind of slowly go through unit by unit and paint through the nodule until we've applied heat to every part of it. It's nice because it's very surgically precise, meaning that you're only treating the nodule. Patients always come in when you're doing surgery, and if they have a cancer or they have a big nodule, and they say, can't you just take out the nodule? Can't you just take out the cancer? And most of the time with surgery, the answer is no, because, well, there's a lot that goes into that, but usually you have to do a lobectomy, at least if you're doing surgery. But RFA is different. It allows you just to take out the part that is problematic. And so because of that, the risk of needing thyroid hormone or affecting your thyroid function at all is not zero, but it's close to zero. It's about one in a thousand patients would have a change in their thyroid function after rfa. So that's the huge win right there. Because if you have a lobectomy, it's probably 30 to 40% of patients are going to require some supplemental hormone. And so for. For patients with benign nodules that are symptomatic or visible or maybe causing some Compression. And they. And they don't really want to go all the way to surgery because of what might happen with hormones afterwards. RFA is an. Is a easy intermediate step that you can hopefully shrink the size of what. Whatever's going on and avoid surgery and thus avoid the need for hormones in the future.

That's incredible. And tell us, take us through, like, what it looks like. Are people under anesthesia? Is it really painful? What's the recovery time like?

Almost exactly the same as with your biopsy. And so if you've had a thyroid biopsy before, it's pretty similar to rfa. It's like, probably a longer biopsy because it usually takes about an hour. And for really big, long, big nodules, it can take even an hour and a half. But that's. That's pretty unusual. But it's the same thing. We numb you up really well. If you need something to help you relax. I mean, I get really anxious during medical procedures on myself. And so if you need something to help you relax, we give you that. But we actually want you to be awake and talking to us so that we can make sure. Because the funny thing about the thyroid is once you get into the thyroid, there are no nerves inside of it. And so the whole time we're treating it, you should not feel any pain. And if you feel pain, it lets us know. Hold on, I need to change something. Because pain is a signal that we're getting too close to your voice box or we're getting too close to something that. And so we can adapt and adjust accordingly. So you're awake. I had one woman, really interesting. She. About halfway through, she said, hey, could you speed this up a little bit? I said, sure, but why? She said, well, I get a blind date in about half an hour.

I love her.

It was fantastic. And so when I saw her back close up, I said, so how. How was your date? No, he's not the guy for me. But you really should tell people that this is going to take an hour and a half to do. Like, okay.

She thought it was gonna be like a quick in and out, like she was getting her nails done, basically. I love it.

Exactly. That's exactly what she thought. Yeah. So it's not quite like getting your nails done. It's more involved than that, but it's. It's pretty straight. I would not. I tell my patients, do not set up dates after rfa, take the rest of the afternoon off. But it's pretty straightforward.

I love that you've added that to, like, their post OP instructions. Basically, no blind dates after this.

So that's great.

No anesthesia. Right. So, I mean, that's a really. That's a big deal for a lot of people. So I know that there are a few different kinds of nodules, right. There are benign types of nodules that are not concerning for cancer, that can be small or they can actually be big enough where they bother people. They have difficulty swallowing or changes in their voice, et cetera. And then there are cancerous nodules that we want to kind of monitor or that create concern. And then there are hot nodules or toxic nodules that lead to an overproduction of thyroid hormones and graves, like symptoms or hyperthyroidism. I'd love for you to take us through how RFA is applicable or isn't applicable for each of these scenarios. I know you've done a lot of research on this and work and in depth in this kind of area. So take us through it.

That's perfect. That's a. That's a great lead in. So number one, let's start with benign, because that's what most people are using it for. With benign nodules, what we expect. There's some rules about this, right? The one advantage that surgery has is once you take it out for sure that there's no cancer inside of there, you've. You've got it in front of you. Anything less than surgery, we have high probabilities that it's not cancer. And so with radiofrequency ablation, we start from a position of saying you have to know as close as you can to assure knowledge that it's not cancer. So that means at least two benign biopsies.

Okay?

And for me, the patient has an indeterminate biopsy. That means there's a chance that there's cancer in there. And I'm not excited about treating people where there might be cancer inside with rfa, But I'll come back. Let's put a pin in that one and we'll come back to that later. Because you can use RFA if you know that it's cancer, but it's different if you've got a big tumor that might or might not be cancer. It's. It's all size dependent. We'll. We'll come back to that one. But if you're very confident that it's a benign nodule, then we go through the treatment cycle and it's. As a surgeon, I'm all about instant gratification, and RFA is not like that. It usually takes at least A month before you even start to feel that it's starting to shrink. And then it keeps shrinking for a year or a year and a half after the treatment. And so you'll have regular ultrasound. Yeah, it's. It's not fast. And that's. And it's. It's kind of disappointing. Right? Like, patients come in, you do all of this, and then you sit back and twiddle your thumbs. I had one patient where it didn't even start to shrink until a full year had passed. And then all of a sudden it went from zero to 60 really quickly.

Wow.

But for most patients, it's about three to six months. You'll start to notice on ultrasound that it's getting smaller. And for about 80% of patients, the nodule size will shrink more than 50% in volume.

Wow.

And so it's important to know if you have like a 10 centimeter nodule, cause I'm sure a lot of your patients do. They have got really big nodules. A 10 centimeter nodule doesn't mean that it's gonna shrink down to 5, 5 centimeters in, in maximal size because volume is exponential. Right. Length times width times height. But it'll get smaller. And usually symptoms get better. And you can treat multiple times. You can do whatever you need to do to keep shrinking it down. Very effective for benign nodules. Works great. And that's what most people choose to use it for. It kind of keeps you out of surgery, hopefully forever and at least for the short term. Next, let's talk about toxic nodules. Toxic nodules are a little bit more nuanced. It if you look at the international data, because RFA and other. We haven't mentioned microwave or nanopulse or any of these, but they're all fairly interchangeable. It's just there's slight nuances, but for. Essentially, they're all the same thing. And as far as functionality, when you treat toxic nodules and you look at the international data, they don't respond perfectly. And so it's kind of like radioactive iodine, where you might have to do it multiple times to get the results that you want. With a toxic nodule, it can be effective, but we find that the smaller the nodule is, the more likely it is to be effective. And if you have fewer than. If you have only one nodule and that nodule is small, it's super effective. We're talking like 90 plus percent that you're going to get a cure and still maintain your normal thyroid. The more nodules you have, the Bigger they are, the less well it works. So for me, our goals are to get our patients to help them become euthyroid as quickly as possible, because we, we understand scientifically that the longer that they're in a hyperthyroid state, the more strain that puts on the heart. And so long term, as far as looking at longevity and mortality and all the rest of that, we want you to become EU thyroid fairly quickly. And so if we know that we're going to have to do a treatment multiple times, we get a little bit, a little bit hesitant to do that. So if you look at international guidelines, radiofrequency ablation is not first line therapy for toxic nodules in the US it can be offered, but I, you always want to do what's best for the patient. Again, that's part of why I do surgery as well. It's, it's radio frequency is a tool, but you don't want to overuse any tool. And so it's very effective. It can work great, but there's nuance that goes into it, and that leads us right into cancer, which is the really exciting one. So I was the first head and neck surgeon to use RFA for cancer in the United for thyroid cancer in the United States. And we did a clinical trial that found that we can get small cancers to disappear a lot of the time on ultrasound. But the question about that is, if it disappears on an ultrasound, does that actually mean that the cancer is fully gone? And we don't know the answer to that question. That's going to take years before we figure it out. International data seems to suggest that there are some situations where even though we can't see it on an ultrasound, if you do surgery, there's still some cancer cells there. That's not for everybody. And the smaller it is and the better location, the more we can treat a margin, the better results we can have. But a lot of these small cancers, you don't need to do surgery for right now, we're doing active surveillance for small cancers as well. And so for patients who are eligible for active surveillance, the idea of doing radiofrequency ablation may provide some peace of mind. You're certainly going to kill some cancer cells, activate the immune system in that area so that they come in and try and clean up the cancer that's in there and hopefully cause some peripheral damage that helps with cancer control. And so a lot of these things we think at the, at a minimum would provide some peace of mind for patients who would be eligible to not have Surgery, and best case scenario, we're gonna look back 10 or 20 years from now and say, hey, guess what? We actually got rid of their cancer completely. So that's the. That's a little bit of kind of a walkthrough of benign, toxic and cancer applicable in all of them. Benign, almost everybody it works for. And then with each one, you get a little bit pickier about what's the right tool to use with how interesting.

And how exciting to be on the forefront of the cancer part. Like, I had emailed you, I think, last week, and I was curious because I had heard that maybe this was starting to be used. And I'm like, have you heard of people doing this? You're like, yeah, sent me like 10 articles of studies that you have already done on this exact topic. So it's so, so unique and special to be driving that kind of care and options for people who historically, literally have had no other options. So thank you for putting in the time and energy and work into driving that discovery and just collecting all of that data. I wanted to ask you too, this is a random question, but do you. Can you think of any really impactful or significant stories with patients you've had who got RFA and kind of take us through, maybe an example if you can think of one.

I can think of. I can think of quite a few I examples in each one. The first cancer patient that we took care of with RFA was a woman who had been waiting for seven or eight years, and she had. She actually, she was a researcher at an institution close by where I worked. And. And she had this small cancer that she had just been watching for a few years. And everybody kept telling her, you need surgery, you need surgery, you need surgery. And the first time that she came in, she's like, look, she had reasons that she didn't want to do surgery that were other medical reasons. She said, I don't think it's going to be safe for me to do that. And within about six months, we couldn't see it on an ultrasound. It had just totally disappeared. And that was our very first one. And it was so gratifying just to like. Because, I mean, she still needs follow up, right? It's not like we're saying, see you later, but just the peace of mind that she was able to have just by saying, hey, I did something about this. My doctors aren't pestering me about it all the time. You can't even see it on an ultrasound anymore. That was really. That was super satisfying. There's Another woman who had such a big, benign nodule and hers was so massive that anytime she did yoga or anything like that, she started to have stridor. So her breathing got really noisy. And, and so I see her and I say, hey, look, Kesha, RF is only a tool. Like, it's. I would not recommend, but I frankly, we think that you need surgery. This thing is so huge neck, just like on the pictures that you see sometimes from people that live in other countries. And I'm like, I. I think surgery is probably my recommendation. She completely averse to the idea of surgery, spent a lot of time talking to her, and I said, look, let's try it once. We'll see what we get with you, and we'll go from there. And within three to six months, her stridor had gotten better. She was able to exercise without having the noisy breathing. And. And so I say that with some caution. I still think that she probably would have been better served with surgery. Actually. There's a new treatment that I'm trying to get her plugged into called thyroid artery embolization, where you kill the blood vessels that feed the thyroid. And so for really massive thyroids, that may be the best option. Even better than radiofrequency ablation. There's risks just like anything, there's risks that go into it with that. But there's so many cool things like we talked about, like the whole field of thyroid is just not kind of. When I was still working a lot with trainees, I would just tell them, hey, it's good. You have to master all of these things. But 10 years out from my training, I do about 25% of what I do is things that I learned during training, and 75% is things that weren't even around when I finished my training. That's kind of fun.

I love that. Like, that just. That says so much about you keeping up with the progress of everything. Because not every clinician, physician, surgeon, I'm sure, is. Is that way, Right. To stay up to date on all that is, is a part time slash full time job.

That's true. It's fun. It's. And. And you would you feel, I don't know, you kind of feel obligated when you're sitting across from the patient to at least know what's going on in the field, right?

Yeah.

The same for you. If they invent some magical medication that fixes all thyroid problems, you're gonna know about it because it's your life, right?

Right. Totally. I love it. Well, one other Thing that I did wanna bring up, changing shifting gears a little bit, is something you brought up in our conversation we had a week or two ago that admittedly I wasn't even aware of. So I'm kind of excited to bring it to the listeners. But that is scarless thyroid surgery. So I want you to kind of one, tell us about normal thyroid surgery, right? Like, tell us what that looks like, what the long term, kind of even the aesthetic component of it is, and then compare to scarless thyroid surgery. And I think my question to you is, like, how does that even work? And it was fascinating when you told me. So take us through it.

Okay, we'll start with normal thyroid surgery, which is really good. Like, again, it's. What made me fall in love with the field of thyroid and parathyroid surgery was that this is a very elegant surgery and you can. And patients almost always do super well. Sometimes we have to send them to you afterwards to help iron out the hormonal issues. But as far as safety and getting patients recovered, it's a pretty safe surgery if you go to a surgeon who does lots of thyroid surgery, right? And so cosmetically, at the end, there's a little bit of a concern. Most of our patients are women, and most of them aren't super excited about having a fairly prominent scar right in the middle of their neck after surgery. And over time, for the vast majority of patients, it heals pretty well. And for a lot of patients, it can almost become invisible. But we know that it makes people self conscious. And so we did a study at Hopkins. One of the. A really fun study was we put pictures of different patients in front of just random people off the street. And we would have them sit in front of these pictures and say, hey, now tell us what you think about this person. If you have a scar, if you don't have a scar. And then they would just ask them to pass judgment, like, what do you think about this person? And it turns out that if you have a scar in the middle of your neck, other people perceive things about you. They perceive that you have a lower quality of life than they do, right? They perceive that you're less attractive than people without a scar, which is so crazy, right? But we took that one step further and we looked at people's pupils. And so if you and I are talking and I have a scar on my neck, your eyes are just going to naturally drift down to look at the scar. And we've all been talking to somebody and, you know, might have a pimple or something. Like that. And we've felt their eyes drift down to our pimple, and it's so distracting, right? We're like, dude, look at my eyes. Do not look like. Focus on my eyes. Do not look at my pimple. And it's the same thing. If you have a neck scar, where is it? The end of the world? Certainly not. Treating cancer is more important. Treating whatever pathology, that's the key thing, right? But if we could do it without a scar, we would. You know what I mean? Like, there's no reason not to. And so again, right? Super fortuitous. I feel so blessed. Like, when I finished my training, about three months before I finished my training, this paper came out of, Of Thailand, of all places, where there was. There was the. A surgeon who had done scarless thyroid surgery and published a few cases. And so I finished my training three months later and went to Thailand and learned from the surgeon within three months of. Four months of him publishing that paper and was able to come back and be the first group in the United States to do the scarless transomal thyroid surgery. And at the beginning of your practice, you have time to invest in learning these things. And I had patients who I will forever be grateful to who were like, yeah, let's try it. I mean, that takes a lot of courage to be like a patient. Be like, I walk into the room, I'm like, hey, I'm a brand new surgeon. I just was hanging out in Asia. They've got this idea, you want to do it? And they're like, yeah, sure, let's do it or something. I mean, great patients. I cannot say enough good things about them. And so over time, at this point, we've done. I've. I've done more than 700 of these scarless thyroid surgeries, which is kind of cool. It's about a third to a, to half of my practice at this point. Just as time has gone on, it's. It keeps building up, especially in the last six months. But it, it what we found. So we went back through and we asked all of our patients who had had scarless thyroid surgery. Sorry, I get really excited about this. So we asked all of our patients, like, about their quality of life, right? Because at the end of the day, it's a scar. And a lot of people minimize that. And they're like, oh, it's a badge of courage or honor. I went through something challenging. Totally get that. You know what I mean? I do not want to minimize that at all. You've been through something hard. Wear it. Proudly. But we wanted to know, hey, does this really affect your quality of life or not? Are we doing something better or not? And, and so we sent out surveys, like these validated surveys to all of our patients that we had operated on who were eligible to have scarless surgery in, in about a seven year period. And out of those 2000 patients who were eligible, 700 had scarless and 1300 had open surgery. And the results came back that the people who had scarless surgery had a better quality of life than the people who had surgery with a scar. And it was small because in general, people do well no matter which option they choose, because it's a good surgery. But it was like, so gratifying to, at the end of everything, be like, the last seven years of my life, I actually have been doing something cool. And so that was, that was kind of fun. And, and how do we do it? We make incisions inside of the lower lip. It's just like when you take your gallbladder out. We used to make a big incision that everybody could see, and now you just get these small keyhole incisions and you can't really tell what they're from. We do the same thing, except for we hide the incisions inside of your lip kind of right in this area underneath your lip, and we just do. Otherwise, it's just normal thyroid surgery. We just hide the incisions. So it's, it's pretty fun. I wish I could get more surgeons to take it up. It's. It has been slow getting other surgeons to adopt it for the reasons that we talked about before. Once you finish training, you're busy. It's hard to take time and say, hey, especially for people that are, are kind of recognized as the experts. It takes a lot for them to say, wait, hold on, I'm actually not the expert in this one because this is new. So I'm going to go learn from this other person. And so that's, that's a little bit challenging, but, yeah, hopefully.

So interesting. Tell me about eligibility for scarless thyroid surgery. Like, what makes a person a candidate versus not a candidate?

Most patients. That's the crazy thing. Like, we always thought that it was only going to be these patients who had like extra, like the really small tumors or didn't really need surgery. And it turns out that we did a, we did a study looking at Stanford. Sorry, it was ucsf, University of Chicago and Hopkins. And we put all of our patients in a big bucket and said, out of this bucket, who could have scarless surgery. And it was about 56% of patients were eligible for scarless surgery. And so most of you, most of the people that are listening, if they need surgery, they don't have to have a scar. Now it. There are some people where a scar is the better choice. I had a patient earlier today who was kind of interested in scarless. And if the cancer's in the wrong spot or if it's too big, again, it's a tool. You apply the tool when it's the right thing to do. Yeah.

And I think such a important thing for people to know and recognize is the value in seeing someone that has maybe a larger toolbox. Right. Like seeing someone that can look at multiple options and go through those options and be like, well, this one might work, this one you might not be the best candidate for, but the more options you have, I think ultimately that leads to the best care. And this kind of brings up one. One point that I wanted to share from my perspective. And for years now at modern thyroid clinic, when people need a potential thyroidectomy, when they need a biopsy, when they. When they just need an intensive consult, that is out of our area of expertise. We really encourage people to go to thyroid specific surgeons because there's a lot of people that can technically operate on your thyroid. But it's almost like modern thyroid clinic in and of itself is our niche is this wide, but this is all we do. Right. And so we're really good at the one thing that we do. And when someone's going to operate on you, you want that to be the thing that they do all day, every day, because you're going to end up with better outcomes. You're going to end up with. They'll have more tools in their toolbox that other people won't have. And I think it's easy to just go to the person you get referred to or the person that's two miles from your house. But when it's something that's significant, and I view thyroid surgery or options within that area and zone as very, very, very important, I cannot encourage people enough to go see someone who literally just does that. Like, that's all they do. So that's my.

Now it's my turn to have a bias, but I agree with you.

Right, Right. I mean, it's the.

I imagine it's exactly the same with you. So even when you started as a very focused practitioner 10 years ago on thyroid, your toolbox has continued to expand. Now you don't offer just levothyroxine to everybody that walks in the door, you've got. And you don't just offer armor, right. It's like you've got all sorts of things that you work through. And you say, okay, we're gonna craft a plan that's going to get you to where you want to be and that it's more than just not diseased. It's actually, well, right. And we're gonna help you walk down that path to get there. And that's what makes our jobs fun. If it was cookie cutter for everybody, the same thing every single time, we just AI would take over it and it would. It'd be boring, right? But it's. It's fun because you craft a personalized plan for every single patient, and it's.

Fun to just evolve. To evolve your skill set and your knowledge and what your offerings are for these people. And yeah, I think there's so many parallels with our journey, but I definitely think that's one of them.

Well, I was thinking, and you can probably relate to this as well, We. We hear over and over that it's 10,000 hours to master something. Right. And if you think the average thyroid surgery is maybe a couple hours, and a lot of them take up to five hours if you're taking out lymph nodes and things like that, to be a master surgeon, you're. You've done thousands of thyroid surgeries at this point, right. And so, Mo, 75% of thyroid surgery in the United States is done by somebody who does two to five thyroid surgeries each year. 75% were the United States of America. Like, how is this.

Immediately, no. Immediately. No. Yeah.

So, yeah, yeah.

That is not who I want my patients. Like, I don't want them getting operated on in that kind of way. So, yeah, absolutely. I want you to. One other question kind of in the same genre, is how do you see the role of minimally invasive techniques like RFA or scarless thyroid surgery evolving in the next five to 10 years, or just thyroid surgery in general?

It's. So it's going to go one of a couple of different ways. Right. The way that we all hope that it goes is that practitioners are responsible and we recognize the time and the place to use it. And if we can do that safely, then we'll recognize that it helps almost all of our patients to have options. And it helps probably a third to our half. Half of our patients avoid surgery maybe forever and certainly for the short period of time. But the other concern is that there's always this risk of abuse. Right? That if you have something, if all you have is a hammer, everything looks like a nail. And there are certainly some doctors, certainly around the world, internationally, but. But even some people here who. I. I was talking to a doctor at one of our conferences just not very long ago. It was actually the American Thyroid association who said, yeah, I have patients with toxic nodules who I have not sent for radioactive iodine or surgery. I haven't sent any patients there for the last eight years because all I've done is rfa. And anytime that somebody says none of my patients, I always think it always. It always makes me pause. The world is too big of a place to have one tool that works for everything. And even. And so I think if we see it become abused, then there will become a backlash against it. And like a lot of really good technologies, it won't be offered because it was used in an unsafe fashion. So make sure you're hearing all sides of the coin. And if you go to somebody who's just a surgeon and all they do is surgery, ask questions, and if you go to somebody who just does rfa, ask questions, you need to. And. And that might be a really good person to do it in the end, but you need to hear the other side of the story before you get there.

Absolutely. That is so insightful and incredibly important. I. I hadn't even thought about that. But, yeah, if there's no one size fits all in medicine, everyone can't fit into one little box. Right. I couldn't agree more. Um, tell me a little bit about your practice where people can find you. I do know that you take out of state people. I would love for you to tell listeners about that experience and kind of, in case they are interested or want to know more, paint a picture of. Of what that looks like.

Yeah. So a lot of our patients come from national but also international sources, and we, when we're trying to set that up, we try to make it as easy as possible. The nice part is most thyroid patients, like you alluded to earlier, they're educated, they're prepared, they have a sheaf of information from the years of biopsies that they've had. And so if they can send us that beforehand, we can usually craft a pretty good idea about what we're going to need to do by the time they get to us. And so we'll set up a plan where they'll come in and they'll. My preferred is I'll see you on one day and then do the procedure the next day. Sometimes we'll see you and do the procedure the same day. But I prefer to kind of give patients a night to like, think about it and say, okay, is this what I feel good about? Like, digest everything? And then they show up the next morning and we can say, okay, this is what we're gonna do. We make exceptions on that. But the goal is we get you in, we get you treated, and we get you home. If it's rfa, usually the next day, you're fine to fly home. If it's surgery, we would usually want you to stick around. My. I love it if you stay for a week because that gives me lots of comfort. If you stick around for 72 hours, usually we're okay. As long as you're recovering, fine.

I love it. That's. That was gonna be my next question, actually. How long do people need to stay post op? So that's very, very helpful. And then tell everyone where you're located, the name of your practice, and even, like, where can people find out more information about you? I know you're on social media and you really share so much great information there, so I'd love for you to tell them about that as well. I love social media for medical, kind of empowerment for people.

Yeah, it feels really weird to do social media as a doctor. It's. It just feels really weird. But I also recognize that it's a source of great information. I look to people like you and what you've done and been able to really get good information that patients don't get in another way unless they can find you through something like this. And so, yes, I'm dipping a toe into social media, trying, trying to look up to your example on that one. But yeah, so we're in Columbia, Maryland, which is kind of closer, a little bit closer to the D.C. area. There's a few airports that are pretty close by. You can reach us at. We're at the Russell center for Endocrine Health is the name of the practice, kind of with the idea that it's not just about thyroid surgery or parathyroid surgery, it's about endocrine health. Right. And if we have something that fits into your future of, of achieving health and wellness, then fantastic. That's where. That's where we want to help you out. And then. Or you can just email us at. It's inforussell. Dash center. Com.

I love it. And then do you have like a guide or anything that you could offer to listeners to maybe learn a little bit more about what we talked about today?

Yeah, so we have a couple of different things. So we've got a booklet that we made about RFA and just kind of the the guiding principles behind it and how it works. That was fun. That was something we actually made while I was still at Hopkins and it's fun to be able to use it now for patient education. And then we also just have something that we've created just a Russell center specific guide about hey, this is what it looks like to become a patient and this is what it looks like as you who might be eligible and who we would usually want to see you and consider all of the options before we jump to a conclusion.

I love it and I will put both of those in the show notes for anyone listening. Well, I am so grateful for this conversation we were able to have today for listeners. I'm bringing Dr. Russell back to talk about Parathyroid, so that episode will be airing sometime soon as well, so be sure that you tune into that. I am incredibly grateful for you taking the time to do this, but also the energy and time it takes for your line of work to progress options for all of these people listening when it comes to thyroid surgery. Invasive but also non invasive. So thank you for that. This was absolutely insightful and a delightful conversation.

Likewise, thanks so much for all that you do.