TL;DR: No. Nanopulse has not been proven to be safe or effective as a treatment for Graves' disease

There are many different treatments that can be used for Graves' disease. Recently, an older technology has been proposed as a new solution to this old problem. First, let's review what Graves' disease is, what Nanopulse is, and how some people propose that Nanopulse could be used to treat it. Finally, we will review the treatments that have been proven to work and talk about why these are superior to nanoulse.

What is Graves' Disease?

Graves' disease is an autoimmune disorder in which your body creates antibodies that attack your thyroid. In that way, it is similar to the more common autoimmune thyroid disease, Hashimoto's thyroiditis. Instead of destroying your thyroid immediately, however, Graves' Disease stimulates your thyroid to grow and to release more hormone. When your body releases additional thyroid hormone, it increases your metabolism. Symptoms of Graves' disease include sweating, heart racing, weight loss, and tremors among others. More concerning, however, is the knowledge that incompletely untreated Graves' disease can shorten your life, usually by increasing your long term risk of dying due to a heart problem. Even though the thyroid is "not to blame" for this autoimmune problem, treating the thyroid is the only proven way to treat Graves' disease. Anything else visible online has been debunked as a long term treatment strategy.

How is Graves' Disease Treated?

Traditionally, Graves' disease is treated with surgery, anti-thyroid drugs such as methimazole, or radioactive iodine. Each is effective for different patients.

Surgery (total thyroidectomy) has the best long term benefits for patients, meaning that they will both live longer and feel just as well as with any other treatment method. Thyroid hormone is usually necessary. People worry about weight gain, but weight gain is equivalent for patients no matter which option they choose- if they are fully treated. The most appealing benefit of surgery is that the anti-thyroid antibodies usually resolve over time (meaning that your Graves' disease would be cured). Also, if you have thyroid nodules, those nodules can be formally diagnosed and treated so that you don't have to worry about them in the future. Total thyroidectomy for Graves' disease can be done via a scarless transoral thyroidectomy for most patients who would prefer to avoid a visible incision, although not all surgeons are comfortable with the technique.

Anti-Thyroid Drugs are another common option, especially at first diagnosis. Some patients will have a resolution of their disease (known as spontaneous remission) after a period of time. Usually, drugs will be tried for about 6 months. Some patients may still need to take thyroid hormone after this treatment. In addition to liver and bone risks, the important thing for women of child-bearing age to realize is that these all of these medications can cause birth defects. Weight gain is usually equivalent to surgery when drugs are dosed appropriately.

Radioactive iodine treatment (RAI) involves taking a small dose of radioactive iodine which is preferentially concentrated in the thyroid, leading to thyroid death. This treatment is associated with an INCREASE in thyroid antibodies after treatment, and it is not appropriate for people who smoke or those with thyroid eye disease because it will affect eye symptoms even more. People with thyroid nodules may not want to choose this option because the nodules will still need long term observation. Some patients may still need to take thyroid hormone after this treatment, weight gain is equivalent, and there is a small risk of other cancers later in life.

There are new drugs in testing currently that may also block the effects of thyroid hormone. These are currently involved in clinical trials, and it is important to realize that each of these drugs will require long-term dosing, and perhaps need to be taken for the rest of life.

What is Nanopulse Thyroid Ablation?

Nanopulse is an older technology with a new application. This technology uses short bursts of electrical energy to destroy cell membranes. Similar to other ablative technologies, the energy is delivered with a needle via the skin. Different from those technologies, however, the procedure is usually performed under general anesthesia. For that reason, and others, the costs are usually similar or more expensive than surgery. There are a few proposed advantages: because the technique does not use heat, some believe that it will be safer near nerves and other critical structures like the trachea.

A significant limitation of nano pulse use in the thyroid is that there have been very few independent studies of this technique. In other words, most of the research saying that this technology works is coming from the company itself, or doctors who are paid by the company.

How Could Nanopulse be Used for Graves' disease?

Nanopulse and thermal technologies such as RFA or Microwave Ablation have been suggested to have a role for Graves' disease. The idea is that the thyroid tissue can be destroyed with Nanopulse instead of removed during surgery. Either option results in equivalent destruction of Graves' disease, and both options require general anesthesia with treatment related risks

Why are Nanopulse, RFA, and MWA not Safe for Graves' Disease?

Nanopulse and these other techniques like RFA attempt to destroy thyroid tissue, similar to surgery. The ultimate goal is to leave a patient with a destroyed thyroid that is not functional, which would be a cure for Graves' disease but leave the patient on thyroid hormone for life. Unfortunately, the area near the thyroid has very complex anatomy: the windpipe, esophagus, carotid artery, parathyroid glands, and voice box nerve all touch the thyroid. During surgery, the surgeon is able to fully examine these structures and move them out of the way. If a surgeon uses a technique that doesn't offer the ability to directly visualize these structures, they could be permanently injured. To avoid these potentially life-threatening risks, surgeons will usually try to avoid these structures by leaving some thyroid tissue behind. This is known as a sub-total thyroidectomy. This technique has been tried in surgery in the past, and has been rejected because the recurrence rate of Graves' disease is unacceptably high, and there are other complications as well. In other words, a partial thyroidectomy is not a safe surgery for patients with Graves' disease. We have no ability to predict that an ablation technique will be safer, and these techniques have never had significant research to evaluate their safety or efficacy for these causes. We do not know if the destruction of tissue with these techniques will result in a flood of new antigens and make Graves' disease worse, because it is, after all, an autoimmune disease. Finally, any thyroid nodules or cancers inside of the thyroid would not be fully destroyed, and would require other treatment in the future.

Conclusion

Graves' disease is a challenging condition that has multiple treatment paths, none of which are perfect. Thyroid tissue and hormones can be blocked, removed or destroyed. Surgery has been well researched and is known to lead to a cure of Graves' over time, while also eliminating nodules all of which result in proven long term health. Newer options, such as nano pulse, are unproven methods that have great risks and have not been studied well. While they may hold promise in the future, independent studies will be required, and patients should be aware that the goal of nano pulse treatment is to destroy thyroid tissue. Unfortunately, these results are unlikely to be permanent, and could have higher risks that traditional or scarless thyroid surgery.