In-Office Procedures

Thyroid Ultrasound

We perform in-office thyroid ultrasounds to evaluate thyroid nodules, goiter, and thyroid gland structure. Our physicians assess nodule size, characteristics, and risk features in real time — without a separate radiology appointment.

When Is It Ordered?

• Evaluation of a palpable thyroid nodule or neck lump
• Monitoring of known thyroid nodules over time
• Assessment of goiter or diffuse thyroid enlargement
• Follow-up after thyroid cancer treatment
• Evaluation in the setting of abnormal thyroid function tests

Thyroid Fine Needle Aspiration (FNA) Biopsy

When a thyroid nodule requires tissue sampling, we perform FNA biopsy in-office under ultrasound guidance — a minimally invasive procedure collecting cells for pathology review without surgery.

What to Expect

• Performed under real-time ultrasound guidance for precision
• Approximately 15–20 minutes in the office
• Local anesthetic used — most patients experience minimal discomfort
• Pathology results typically available within 1–2 weeks
• No hospital visit, general anesthesia, or surgical incision

Thyroid Microwave Ablation (MWA)

Thyroid microwave ablation is a minimally invasive, non-surgical treatment for benign thyroid nodules that cause symptoms or cosmetic concerns. Using ultrasound guidance, a thin microwave antenna is precisely placed into the nodule — delivering targeted heat energy that shrinks it from the inside out. The entire procedure is performed in-office under local anesthesia, with no hospital stay, no general anesthesia, and no scar. Most patients achieve 70–90% volume reduction within 12 months.

Who Is a Candidate?

• Benign thyroid nodule confirmed on FNA biopsy
• Nodule causing neck pressure, difficulty swallowing, or cosmetic concerns
• Autonomously functioning (hot) nodule contributing to hyperthyroidism
• Patients who decline or are not candidates for surgery
• Selected cases of multinodular goiter

What to Expect

• Thyroid ultrasound and confirmed benign FNA biopsy required beforehand
• Performed in-office under local anesthesia — approximately 15–45 minutes
• Ultrasound-guided microwave antenna placement with hydrodissection for safety
• Same-day or next-day return to normal activities
• Follow-up ultrasound at 1, 6, and 12 months to assess nodule reduction
• Thyroid function preserved — no effect on healthy surrounding tissue

CGM Initiation & Training

We initiate and train patients on CGMs including Dexcom G7 and FreeStyle Libre 3 directly in our office — providing real-time glucose readings and trends that improve diabetes management for Type 1 and Type 2 diabetes.

• Device selection guidance based on insurance and clinical needs
• Hands-on sensor placement and smartphone app setup
• Integration with insulin pumps and automated insulin delivery systems
• Remote CGM data review between office visits

Eversense 365 Implantable CGM — Insertion & Management

The Eversense 365 is the world's only fully implantable continuous glucose monitor, lasting up to 365 days on a single sensor. Unlike traditional CGMs that require frequent patch changes every 10–15 days, Eversense 365 uses a tiny sensor — smaller than a pill — inserted just under the skin of the outer upper arm in a brief in-office procedure. A rechargeable smart transmitter worn over the sensor sends real-time glucose readings to your smartphone every 5 minutes, with on-body vibration alerts for high or low glucose even when your phone isn't nearby.

Who Is a Candidate?

• Adults 18+ with Type 1 or Type 2 diabetes on insulin, or at risk for hypoglycemia
• Patients frustrated with frequent sensor changes (every 10–15 days)
• Those who want the freedom to remove their transmitter for swimming, contact sports, or MRI
• Patients who prefer discreet, vibration-only alerts without phone dependency

What to Expect

• Insertion performed in-office under local anesthesia — approximately 15–20 minutes
• Small sensor placed just under the skin of the outer upper arm
• 24-hour warm-up period before readings begin
• Real-time glucose readings every 5 minutes transmitted to the Eversense app
• Weekly fingerstick calibration required once a week (after Day 13)
• Sensor removal and replacement also performed in-office after 365 days
• Our team assists with insurance pre-authorization and ongoing CGM management

Prolia (Denosumab) Injections

Prolia (denosumab) is an FDA-approved injection for osteoporosis given every 6 months that inhibits bone resorption to reduce fracture risk. We administer Prolia in-office and coordinate scheduling to maintain the correct dosing interval.

• Given every 6 months — timing is critical to prevent rebound bone loss
• Calcium and vitamin D checked before each dose
• Contraindicated in hypocalcemia
• Transition therapy required when discontinuing Prolia

Evenity (Romosozumab) Injections

Evenity (romosozumab) is an FDA-approved injectable treatment for severe osteoporosis in postmenopausal women at high risk of fracture. Unlike Prolia, Evenity has a dual mechanism — it simultaneously builds new bone and reduces bone breakdown, making it one of the most powerful bone-building agents available. It is administered as two subcutaneous injections once monthly for 12 months, after which transition to an antiresorptive therapy is required.

• Two subcutaneous injections given once monthly for 12 months
• Dual action — stimulates bone formation and inhibits bone resorption
• Calcium and vitamin D levels checked before initiating therapy
• Contraindicated in patients with recent (within the past year) heart attack or stroke
• Carries a boxed warning for cardiovascular risk — full cardiac history reviewed before prescribing
• Transition to Prolia or a bisphosphonate required after completing the 12-month course