FAQs: Radio Frequency Ablation of Thyroid Nodules
Radio Frequency Ablation (RFA) is a well known and non-surgical procedure used by medical professionals to deal with benign and malignant tumors. It has been in use in Asia (South Korea) since 2006, as well as Europe and South America. In the US, RFA was approved for use by the FDA in 2019 and has gradually attracted attention as a viable alternative to manage large or symptomatic benign thyroid nodules.
This technique involves using a special needle (a little bigger than the sized used to draw blood) to apply heat energy into a benign thyroid nodule. Low frequency electrical waves are generated to heat the tip of the special needle, which precisely cauterizes the nodule causing tissue destruction and regression of the nodule. The resorption of the nodule takes places over the course of months.
Early on following your procedure, the nodule may actually enlarge transiently, with some increased symptoms of pressure or swelling. This is typically due to swelling related to tissue injury, or a small amount of bleeding into the nodule. This is almost always self-limited and resolves typically within the first week of your procedure. Using an ice pack over the nodule for about 15 minutes per session, 3-4 times a day for the first 48 hours can oftentimes help minimize this issue.
At your 1 month visit, an ultrasound may detect some regression in the size of your nodule although this is not always seen.
At your 3-month visit, typical volume regression is from 25% to 40%, although this may vary depending on your particular situation.
At your 6-month visit, typical volume regression is from 40% to 70%.
By 12 months, the regression in volume has typically plateaued. Total volume regression ranges from 70 to 90%.
This technology is not compatible with pacemakers or implanted defibrillator devices. Please make a note if you have one of these devices, as this technique is not suitable for your situation.
The procedure is best suited for large benign nodules which may be causing local pressure symptoms or a visually displeasing profile. It works best with solid nodules, although RFA works well for both large simple cystic nodules and complex cystic nodules as well. Nodules that are close to critical structures such as the nerve to the vocal cord or large blood vessels may not be amenable to this technique for safety reasons. Your surgeon will perform an ultrasound in the office to determine if RFA is a suitable option for management of your particular situation.
RFA is done in the office with local anesthesia. It takes 30 to 45 minutes in most situations. After the administration of local analgesia, very little pain is experienced. You may experience mild pressure or discomfort during the procedure. If something is uncomfortable, you will be able to voice this discomfort to your surgeon. You may often experience some odd sensations such as a brief “popping” sound. This is normal and to be expected.
No sedation is administered intentionally to permit the patient to voice any issues of discomfort during the procedure. As the patient is not sedated, this technique is oftentimes not suitable for those predisposed to anxiety or panic. A reasonable measure is if the needle aspiration biopsy to confirm benign cytopathology was difficult to tolerate, RFA will not be a good procedure option for you.
After the procedure, ice is applied over the procedure site and most patients are observed for an additional 15 to 30 minutes. The entire visit takes approximately 2 hours from check-in, procedure, cleaning up, and observation. Most patients experience a little post-procedure discomfort. Applying an ice pack to the neck for 15 minutes a day, 3-4 times a day, for the first 24 to 48 hours after your procedure will help with swelling and discomfort. Scheduled Tylenol 650 mg 4-5 times daily as well as ibuprofen can also help with pain relief in the initial days following your procedure.
Our practice is to follow up with an ultrasound at one month, three months, six month and one year to document size change. Larger nodules or goiterous thyroids might require more than one session for full ablation to be effective.
The risks associated with the procedure are very small. The risks include local pain, bleeding, infection, and voice problems and breathing problems. Reported issues from this procedure include nerve injury, injury to adjacent structures such as blood vessels, trachea, esophagus, bleeding, and skin burns. These are very rare occurrences and have never been observed in our practice.
The primary advantage of RFA is no surgical scar (1 or 2 minimal scars from the needle puncture sites are all that it typically requires); less post procedural discomfort; minimal recovery as compared to surgery. It also has less of an impact on thyroid function as only abnormal thyroid tissue is ablated. This leads to the preservation of more normal thyroid tissue and less of an impact on long-term thyroid function. Conversely, up to 20% of patients undergoing surgery for a benign nodule with normal thyroid function may require thyroid hormone supplementation after surgery.
The cost of the procedure is much less than the total cost of surgery. However, because the procedure is relatively new in the US, the participation of insurance companies is variable. We will work these issues out with your insurance company before the procedure so that you will know your financial responsibility prior to the RFA procedure.
You can view this pamphlet which gives some information regarding the procedure as well: