Thyroid nodules are very common. In fact, they may be present in up to 2/3 of the population. In most cases, people are unaware that they even have a thyroid nodule. However, over time, some of these thyroid nodules will grow to the point that they become visible and may start putting pressure on nearby structures giving some uncomfortable and unwanted symptoms.
How long has RFA been around?
Radiofrequency ablation has been around for decades and used successfully in many applications including to treat tumors of the kidney and liver. The first RFA of a thyroid nodule was performed in Korea in 2002, but the procedure has been relatively unknown until just recently. The technique is being adopted throughout the world and we are now able to offer RFA to our patients here in the US.
What Happens During the Procedure?
RFA is an outpatient procedure that is performed right here in our office. It usually takes about 20-30 minutes and is performed completely under local anesthesia. We will make you comfortable while we work and there should be no significant pain during the procedure. The skin and the tissues around the thyroid gland are numbed first. A thin RFA electrode is then placed through the skin and directly into the thyroid nodule. The electrode is moved systematically throughout the entire nodule while energy from the electrode precisely heats up and destroys the tissues of the nodule while preserving all of the surrounding normal tissues and structures. The whole procedure from numbing to ablation is visualized with the ultrasound machine so that we always know exactly where we are working. You’ll be able to talk to us during the procedure to let us know how you are doing. Once we are finished, you will be observed in the office for 30-45 minutes and then you get to go home. Tylenol and ice packs can be used for any soreness after the procedure. Most people are able to return to their normal activities by the next day.
How Radiofrequency Ablation Works
The RFA electrode is placed into the thyroid nodule under ultrasound guidance. When the electrode is activated, charged particles within the cells of the thyroid nodule begin to rub together which causes heat production. This heat destroys the cells immediately surrounding the tip of the electrode. This way we can be very precise about which tissues we ablate and which we protect. Over the next few weeks, the nodule will start to shrink which will improve both the appearance of the nodule but also help relieve any compressive symptoms the nodule is causing.
Watch the video below for a visual representation of the procedure.
How much should I expect my nodule to shrink?
Most patients will notice a significant improvement in their thyroid nodule within a month. Any reduction in size of the thyroid nodule by at least 50% is considered a successful procedure. However, most patients get a much better reduction than that. On average, RFA will cause the thyroid nodule to shrink by 40-60% within 3 months and 60-90% within one year. The nodule can even continue to shrink over the next several years. The average reduction in size is around 80%.
What are the Advantages of RFA Over Thyroid Surgery?
- It can be performed under local anesthesia in the office
- Patients can often return to work and normal activities the next day
- There is no neck scar
- There are no anesthesia or hospital fees
- Very low risk profile, especially as compared to surgery
- The procedure is repeatable if needed. No bridges are burned for future RFA procedures or even surgery
- Preservation of thyroid function
Patients who undergo total thyroidectomy will require thyroid replacement hormone for the rest of their lives. However, 25-30% of patients who only have only one lobe of their thyroid removed may still require this same medicine. With RFA, only the nodule is destroyed which leaves the rest of the tissues of the thyroid untouched and free to continue producing normal thyroid hormone.
Which Thyroid Nodules Are Candidates for RFA?
- Nodules that are visible and unsightly
- Nodules that are causing compressive symptoms, like feeling pressure or a lump in the throat, difficulty breathing while lying flat, or problems swallowing
- Nodules greater than 2 cm that, although benign, continue to grow
- Patients need to have had two separate benign thyroid biopsies or a benign biopsy with classically benign appearance on ultrasound (ex. spongiform or purely cystic nodules)
Which Nodules Are Not Candidates for RFA?
- Cancerous, suspicious or indeterminate nodules
- Pregnant women
- Patients with pacemakers or defibrillators
- Heavily calcified nodules
- Large substernal goiters
- Nodules in areas not accessible with RFA like behind the trachea or deep in the chest
- Patients unable to be off of blood thinners
Will I Need More Than One RFA Procedure?
Most patients will require only one procedure to take care of their thyroid nodule. However, some nodules may need more than one.
- Larger nodules, especially those over 4 cm, may be too large to fully shrink with a single procedure
- Some nodules may be partly or completely filled with fluid (cystic). The higher the percentage of fluid in a nodule, the higher the chance of needing a second procedure.
- Some nodules are situated right next to critical structures in the neck like the vocal cord nerve and the esophagus. To help protect these vital structures, sometimes nodule tissue has to be left behind. If these tissues grow over time, another RFA procedure may need to be performed.
Radiofrequency ablation offers an exciting and cutting edge non-surgical option for treating certain benign thyroid nodules. Not all patients are candidates for RFA, but if surgery has been recommended and you are looking for a non-surgical option, let us meet with you to see if RFA is the right choice for you.
Dr. Benjamin Webb is the first thyroid surgeon in San Antonio to offer RFA to his patients. To find out more about Dr. Webb, check out his bio.