Radiofrequency Ablation (RFA) for Thyroid Nodules: A Comprehensive Guide

A Brief History of Thyroid RFA:

The concept of radiofrequency ablation (RFA) itself dates back to the 1930s. It is used for the treatment of benign and malignant tumors in various areas. It is also used to disrupt nerves that
are causing pain in the neck and back. Its application in thyroid nodules is a more recent development. The first documented use of RFA for thyroid disease was reported in 1998. Since then, the procedure has gained traction, particularly in Asia and Europe, as a minimally invasive alternative for managing both benign and, in some cases, low-risk cancerous thyroid nodules.

What is Radiofrequency Ablation (RFA) of the Thyroid?

Radio frequency ablation, or RFA, is a minimally invasive procedure used to shrink thyroid nodules. A needle shaped electrode is guided into the nodule using ultrasound. The electrode is then activated while it is in the nodule. Unlike traditional surgery, which involves removing the nodule with a scalpel, RFA utilizes radio waves to generate heat. The electrode is moved through the nodule to treat the whole area. This heat disrupts and destroys the targeted tissue within the nodule, causing it to shrink over time. The surrounding healthy thyroid tissue remains unaffected.

Types of Thyroid Nodules Treated by the RFA Procedure

While the RFA procedure induces substantial thyroid nodule volume reduction, there are certain qualities of a nodule that make it a better candidate for this treatment:

Solid thyroid nodules that have been confirmed benign
Thyroid nodules that are causing pressure and cosmetic issues
Over-functioning thyroid nodules

Why Consider RFA

RFA has emerged as a valuable alternative to traditional treatments for thyroid nodules, such as surgery or radioactive iodine (RAI) therapy. It may be considered for several reasons:

Symptomatic Benign Nodules: These are non-cancerous nodules that cause discomfort, like trouble swallowing (dysphagia) or breathing (dyspnea). If the nodule is pressing on surrounding structures, RFA can alleviate these symptoms by reducing its size.
Large, Benign Nodules: Large nodules can be a cosmetic concern for some patients. RFA offers a minimally invasive approach to reduce the size of the nodule and improve appearance.
Toxic Nodules Causing Hyperthyroidism: RFA can be a treatment option for toxic nodules, which are nodules within the thyroid gland that overproduce thyroid hormones, leading to a condition called hyperthyroidism. This can be a suitable alternative for patients who are not ideal candidates for surgery or RAI therapy due to underlying health conditions or a preference for a less invasive approach.
Certain Thyroid Cancers: In some cases, RFA may be an option for small, low-risk papillary thyroid cancers, particularly if surgery is not preferred or poses a higher risk due to underlying health conditions.

Advantages of RFA:

Minimally Invasive: RFA avoids the use of a scalpel or large incisions, minimizing scarring and discomfort.
Outpatient Procedure: Typically, you can go home the same day after the RFA procedure.
Faster Recovery: Compared to surgery, RFA offers a quicker return to normal activities, with minimal downtime.
Reduced Risk of Complications: There’s a lower chance of nerve damage orsignificant scarring compared to traditional surgery.
Preserves Thyroid Function: Unlike RAI therapy, which destroys thyroid tissue throughout the gland, RFA aims to shrink only the targeted nodule while leaving healthy thyroid tissue intact, potentially reducing the need for future hormone replacement therapy.

Risks and Complications of RFA:

While generally safe, RFA does carry some potential risks and complications, including:

Pain or Discomfort: You may experience some soreness or discomfort at the treatment site following the procedure. This can usually be managed with medication.
Bruising or Swelling: Temporary bruising and swelling around the treatment area are common.
Vocal Cord Problems (Rare): There’s a small risk of temporary vocal cord problems due to the proximity of the thyroid gland to the nerves controlling the vocal cords.
Bleeding (Rare): Minor bleeding at the puncture site can occur.
Infection (Rare): As with any medical procedure, there’s a slight risk of infection.
Incomplete Ablation: The nodule may not shrink completely in all cases, requiring repeat procedures.
Need for Repeat Procedure: Depending on the size and characteristics of the nodule, additional RFA sessions may be needed to achieve the desired results.

What Happens During the RFA Procedure?

This is an outpatient procedure. It is done in the clinic setting, and you go home after the procedure. There are typically no restrictions once the procedure is done.

Some people prefer a light sedative medication which can be prescribed prior to the procedure. Please take the medication approximately 1 hour before the procedure is to start. If a sedative is used, you will need someone to drive you to and from the appointment and to be with you at home the rest of the day.

You will change into a gown and be placed in the clinic chair. Special adhesive electrodes are placed on each leg. The clinic chair is then reclined backwards so you are lying face up. Your neck is then cleansed and draped for the procedure. Lidocaine injection is then used to numb up the skin and the proposed track of the RFA probe needle. This injection can cause some discomfort before the numbing starts.

Next, using ultrasound guidance, the probe is placed into the skin and guided into the nodule. Once placement is correct, the electrode is then activated. This causes the tissue around the probe to heat up and become disrupted. The needle is then moved to different places in the nodule until it has been entirely treated. The procedure is typically very well-tolerated with minimal discomfort. More lidocaine can be given as needed.

When the procedure is completed, the neck is cleansed, and an adhesive bandage is placed. You then remain in the clinic for 20 to 30 minutes to ensure good recovery before being discharged to home. The procedure can take up to 1 hour. You should be ready to be in the clinic for at least 2 hours total.

Are You a Candidate for Thyroid RFA?

The indications for thyroid radiofrequency ablation include:

Problems swallowing, also called dysphagia. The enlarged thyroid nodule puts pressure against the side of the throat or esophagus and causes food to feel like it is sticking. It will often feel like you have to take a couple of swallows or a sip of water to get the food to pass.
Nodules that are visible on the outside of the neck.
Nodules that are releasing too much thyroid hormone causing hyperthyroidism.
Some small, low risk papillary thyroid carcinomas can be treated. The tumors must be less than 1 cm and show no evidence of metastatic disease to the lymph nodes.

All nodules should be biopsied 2 times using fine-needle aspiration techniques in order to ensure that there is no malignancy.

It should be noted that the gold standard and most commonly accepted therapy for symptomatic thyroid nodules is surgical removal.

Who should not get radiofrequency ablation of a thyroid nodule?:

Pregnant women
People with pacemakers or other electronic implanted device
Sometimes the location of a thyroid nodule will not allow good access with the probe
Cystic (fluid-filled) nodules

If you have a thyroid nodule and are interested in the RFA procedure, contact our clinic today for a consult. Our physicians work with you to develop the most appropriate and advanced treatments and care.

How Does RFA Treatment Work?

The RFA procedure usually is completed after an hour, depending on the size of the nodule, and is performed under local anesthetic (numbing the treatment area only). Once the area is numbed, an ultrasound is used to place the tip of the probe (a small needle electrode) in the correct location which then emits radio waves to heat and destroy the target tissue.

Following the treatment patients typically leave with a small bandage at the site and may experience minor discomfort and bruising, which can be treated with over-the-counter pain medications.

What to Expect After RFA:

You will likely experience some soreness or discomfort at the treatment site, which can be managed with pain medication.
You will be monitored for any complications following the procedure.
Follow-up appointments will be scheduled to track the progress of the nodule size and thyroid function. This may involve ultrasound imaging and blood tests to monitor thyroid hormone levels.

Anticipated Results:

It typically takes several months to see the full effect of RFA on the size of the nodule. Success rates vary depending on the size, type, and location of the nodule. In most cases, RFA can significantly reduce the size of the nodule and alleviate any troublesome symptoms.

Does insurance pay for thyroid RFA?

Insurance companies are increasingly covering radiofrequency ablation for thyroid nodules; however, the procedure is still relatively new, and some cases may not be covered. Our team will help you determine if your insurance provides coverage for the procedure and if not, we will discuss options. Our clinical team will contact your insurance to determine if the procedure will be covered. If not, there are options for self-pay.

There are an increasing number of insurance companies now covering radio frequency ablation for thyroid nodules. Still, some cases are not covered.

At Home Thyroid Radiofrequency Ablation Recovery FAQ

What should I expect after my thyroid radiofrequency ablation?

You will see swelling or bruising develop in your neck or throat area after your procedure, and you may also notice firmness, a pulling sensation, or even have some changes in swallowing. These changes are normal and expected, but can be uncomfortable. You may notice these changes increase over the first 1 to 2 weeks, but they begin to go away over the next 6 to 8 weeks.

You may notice small puncture sites made from the needle used during your procedure, which may release fluid during recovery. Apply pressure over these areas for several minutes to slow and stop the oozing and a small band-aid or piece of gauze may also be used as well.

Will my neck hurt?

Most patients experience some mild discomfort following the procedure, but you can safely move your neck in all directions and can return to your regular daily activities right after this procedure.

You may notice stiffness or soreness in your shoulders, back, or neck, and may also have tension headaches that can take a few days to go away. These are common symptoms and are best treated with over-the-counter anti-inflammatory medicines, warm compresses, a heating pad to the back of the neck, or light massage. Do not sleep on a heating pad or leave the heating pad directly on your skin for extended periods (more than 15 to 20 minutes at a time) as it can cause burns.

Will my voice be different after this procedure?

Changes in the voice do not happen often, but you may notice a slightly hoarse or weak voice after the procedure. If this occurs, your voice will usually return to normal within 6 to 8 weeks. In most cases, those who have this problem find that their voice changes only last for several days. Permanent hoarseness is rare.

How do I take care of the needle puncture sites?

Do not put ointments, powders, Vitamin E cream, moisturizers, or anti-scar creams on the needle puncture sites until you see your doctor for your follow-up visit after your procedure. If you use a band-aid or gauze to control oozing, you may remove it the day after your procedure or when any oozing has stopped. You can shower the day after your procedure and may remove any band-aids or other dressings and wash with soap and water. You may put a new, clean band-aid or dressing on after your shower if oozing continues.

Are there any diet restrictions?

No, there are no diet restrictions after this procedure. You may eat and drink a normal diet or return to any diet restrictions you had for other health problems before you had this procedure.

When can I go back to normal activities?

You may drive a vehicle if you are not taking any narcotic pain medicine and can freely move your head in all directions without being limited by pain. You may return to work as soon as you would like, which may be as soon as the day after your procedure.

How will I manage my pain at home?

You can expect to have some discomfort after your procedure, which is normal and fades quickly. NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn, Aleve), or acetaminophen (Tylenol) are most helpful for any pain you may have after your procedure. In most cases, over-the-counter anti-inflammatories are more helpful than narcotic pain medicines for these types of procedures. Alternating NSAIDs and acetaminophen often works better than taking them at the same time. Your doctor may tell you not to take NSAIDs if you have certain types of kidney problems or acetaminophen if you have certain types of liver problems.

You may apply a cold pack over your needle puncture sites to relieve pain and help decrease swelling. This is most helpful in the first 24 to 48 hours after your procedure.

How to alternate your pain medicine:

Take 1000 mg of acetaminophen (2 pills, 500 mg each or 3 pills, 325 mg each) every 8 hours alternating with 800 mg of Ibuprofen (4 pills, 200 mg each) every 8 hours. This results in a dose every 4 hours. DO NOT EXCEED 3000 mg OF ACETAMINOPHEN (six 500 mg tabs or nine 325 mg tabs) OR 2400 mg OF IBUPROFEN (12 tabs). For example, if your first dose of acetaminophen is at 8:00 AM:

8:00 AM - Acetaminophen 1000 mg

12:00 PM - Ibuprofen 800 mg

4:00 PM - Acetaminophen 1000 mg

8:00 PM - Ibuprofen 800 mg

12:00 AM - Acetaminophen 1000 mg

Continue alternating every 4

When can I start taking my normal daily medicines after this procedure?

Your doctor will let you know when to resume your regular medicines.

Will I need to take a thyroid hormone after my ablation procedure?

Unless you were already taking thyroid hormone supplements before the procedure, most patients do not need to take any thyroid hormone supplements after this procedure. Your doctor will check your thyroid hormone levels about 6 to 8 weeks after your procedure to make sure your thyroid hormone levels are in the normal range.

How quickly should I expect the size of my nodule to decrease?

At first, most patients notice an increase in swelling of the neck right after their ablation procedure. Over time, after the swelling goes away, the size of the thyroid nodule decreases between 30 to 50 percent within the first month. After 6 months, the nodule size decreases on average between 50 to 80 percent.

Will I need another ablation procedure?

In most cases, one ablation procedure is all that is needed. However, if you have a larger nodule, another ablation procedure may be scheduled. A decision about the need for an additional ablation will be made based on ultrasounds done after your procedure.

When will I receive follow-up care after my ablation procedure?

The nursing staff will call you in the first few days after your procedure to see how you are feeling. You will be scheduled for a post-procedure video or phone appointment within 1 to 2 weeks after your ablation procedure.

When do I need a follow-up visit to recheck my thyroid nodule?

In most cases, you will be scheduled for in-person follow-up visits at one, three, six, and twelve months, after your procedure. Your doctor will tell you about any other appointments that are needed during your twelve-month visit.

When should I call my doctor?

Most patients have no problems after thyroid radiofrequency ablation. However, call your doctor if:

You have more trouble talking or breathing than before you had your procedure.
You see drainage that looks white or tan in color or note a bad odor coming from your needle puncture sites. This is very rare.
You see increased redness that is spreading around a needle puncture site.
Call right away if you have a temperature greater than 101.5 degrees Fahrenheit (38.6 degrees Celsius) or higher. We do not recommend you regularly take your temperature, but only if you feel like you have a fever. It is common to have a low-grade fever in the late afternoon/early evening but does not mean you have an infection.

Who do I call if I have questions?

Call the Puget Sound ENT at 206-838-9514 between 7:30 am and 4:30 pm if you have concerns after your procedure. You may also call at any time if there is a problem. Be ready to share the name of the doctor who did your procedure, the type of procedure, and the date it was performed.

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