Thyroid Radiofrequency Ablation
The thyroid gland is small, but it has a big job. While it is primarily responsible for controlling your metabolism, it ultimately affects nearly every part of your body. Like a car battery, we don’t usually think about it, until it stops working properly.
Although relatively common, nodules in the thyroid gland can affect how it performs and cause symptoms directly. Even though the vast majority of nodules are benign and not life-threatening, they can still cause problems. Some benign thyroid nodules may cause discomfort, problems with swallowing, produce excess thyroid hormone, or even cause cosmetic concerns.
Traditionally, thyroid surgery or radioactive iodine would have been the only treatment options for problematic thyroid nodules, depending on what the problem is. While either is generally safe, there are drawbacks to both.
Thyroid surgery, while a very safe procedure, is still surgery. It requires a trip to the hospital, general anesthesia, and the risks that come with both of those. Cosmetically, one often ends up trading a lump for a visible scar.
Similarly, radioactive iodine therapy has its challenges. Special precautions must be taken to protect others from exposure to the radiation. Additionally, there are short term side effects such as nausea, swelling, neck tenderness, dry mouth, a metallic taste in the mouth and an increased risk of other cancers.
In the United States, these methods have been the only options for patients dealing with thyroid nodules—until now.
Thyroid Radiofrequency Ablation: An Advanced, Non-Surgical Treatment of Thyroid Nodules
A common practice in other countries, radiofrequency ablation (RFA) is now available at Surgical Associates. This non-surgical alternative shrinks the nodules usually without compromising thyroid function and helps avoid the long recovery times of thyroid surgery.
What is Radiofrequency Ablation?
Radiofrequency ablation is a medical procedure where dysfunctional tissue is being ablated using heat generated from alternating current, passed from the generator to the tissue via an electrode. Performed under local anesthesia, radiofrequency ablation is relatively painless and does not require general anesthesia. Your doctor will use guided ultrasound to insert the probe into the thyroid nodule. Through selective heating of the probe tip, the nodule is cauterized. The cauterized tissue is then broken down by the body over the course of months.
Advantages of Radiofrequency Ablation of Thyroid Nodules
Compared with surgery, the primary advantages of radiofrequency ablation are:
- Increased likelihood of preservation of thyroid function
- The potential of fewer complications
- Generally shorter recovery time with a quick return to normal activities
- No external scarring
- A shortened procedure: between 15 minutes to one hour
Radiofrequency ablation is highly effective for benign thyroid nodules. Nodules shrink anywhere between 60-90% after one year, with approximately 80% on average.
Radiofrequency ablation takes place in an outpatient setting. Although you will not be under general anesthesia, you will need to follow some pre-procedural instructions from Surgical Associates.
Your medical provider will review the list of your current medications and provide instructions. In most cases, your medications will not affect the procedure. If you take medication for diabetes or high blood pressure, you will most likely be instructed to keep taking it.
If you’re on blood thinning medication, you will probably need to stop taking it for a few days prior to the procedure.
Be sure to inform your physician if you have a pacemaker, implants, are pregnant, or are on any medication (especially for blood thinning). Don’t wear makeup, lipstick, or any metal jewelry on the day of the procedure.
You will be able to breathe, swallow and talk normally the entire time. Two grounding pads will be attached to your thighs.
Your neck will be cleaned and head will be placed on a small cushion with your neck extended. The doctor will administer local anesthesia in the area surrounding the thyroid.
The doctor will ask you several times during the treatment how you are doing and whether you feel pain, and can easily give you more local anesthesia if you are uncomfortable at any time.
How it works
A generator creates an electric circuit. The electrode is designed to optimally deliver energy to the area that is being treated.
During the procedure, the doctor will place the tip of the probe into the thyroid nodule. The generator creates a high frequency wave and sends it directly to the end of the probe. Your doctor can adjust the area being treated as needed to ensure you achieve the desired results.
You will often hear background noise and “mild popping” sounds throughout the procedure. These sounds are normal and signify an appropriate response is taking place.
After monitoring for a short period of time, you will be discharged. Please check with your doctor before you drive, as you may need someone to drive you to and from the procedure. You should be able to return to most of your regular daily activities almost immediately.
Your doctor may provide temporary limitations, however. These may include the following:
- Lifting heavy objects (over 10 pounds)
- Strenuous physical activities
- Any activities that cause pain or discomfort in your neck (such as massage or acupuncture)
In general, radiofrequency ablation will not affect your energy or strength. If you feel any abrupt changes after treatment, you should notify your physician immediately.
Can I be treated with radiofrequency ablation?
Radiofrequency ablation for treating benign thyroid nodules is recommended for patients with:
- Benign thyroid nodules that produce symptoms or cause cosmetic concern
- Nodules that produce excess thyroid hormone–these are known as autonomously functioning, or “hot” thyroid nodules (AFTN)
Radiofrequency ablation is not recommended for patients with:
- Thyroid cancer, thyroid nodules with a biopsy result that is uncertain as to whether there is cancer present
- A nodule that meets U.S. criteria of cancer, despite FNAB (fine needle aspiration biopsy) or CNB (core needle biopsy) results
Radiofrequency ablation is not performed during pregnancy or on patients with implanted pacemakers or defibrillators.
How long does the procedure last?
While the procedure itself takes less than an hour, the entire process may take 2-3 hours. Pre-procedural care and post procedural monitoring takes an additional hour. When the procedure is complete, a small bandage will be placed on the treatment site, and the neck may be cooled with ice packs.
Is radiofrequency ablation painful?
The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain. Other than the initial injection of numbing medication, the only remaining sensation is generally pressure. Intermittent sensations of discomfort thereafter can be treated with additional doses of pain medication or adjustment of the probe tip.
Radiofrequency ablation does not cause any scarring to the external neck. In many cases, one puncture of the skin is sufficient to treat the entire thyroid gland.
What happens to the nodules after treatment?
In the weeks following the procedure, the cells of the treated thyroid nodule are removed by the body’s immune system. Most patients notice the nodule has become smaller in just two to three weeks, with solid nodules taking longer than cystic nodules.
Part or all targeted thyroid nodules may be permanently destroyed during the procedure. Immune cells of the body then break down the affected areas, which shrinks the nodules. The percent reduction depends on the original size and nature of the nodules, with around 40-60 percent after three months and about 60-90 percent after one year.
In the years after the procedure, all that remains in the treated area is scar tissue. While some of the nodule around this scar may remain, it is generally significantly smaller than the same nodule before treatment. The surrounding healthy thyroid gland remains unharmed and can continue to produce thyroid hormone.
Often, difficulty swallowing, feelings of pressure or tightness of the throat, or even the bulk appearance of the nodule is usually significantly decreased or no longer detectable.
Are there any side effects or complications?
While uncommon, complications can include:
- Temporary voice changes, such as hoarseness
- Slight bleeding—usually disappears on its own within one day, or at the most, up to three months
- Wound infections
- In rare cases, vomiting, cough, or seared skin at the treatment site may occur.
- Patients with AFTN (“hot” thyroid nodules) have the possibility of hypothyroidism after the procedure.
Although rare, a complication may require an inpatient hospital stay or follow-up treatment.
Is there any follow-up care?
Following radiofrequency ablation, your physician may monitor the treated nodules with ultrasound scans or lab tests.