Thyroid Radiofrequency Ablation (RFA)

Thyroid RFA is a minimally invasive procedure that uses ultrasound for guidance and a special electrode that transmits radio frequency waves into the thyroid nodule that generates heat and in turn reduces the size of the nodule. This cutting-edge RFA technology is used to treat thyroid nodules that are non-cancerous.

Large benign nodules that negatively affect your voice and/or breathing are the best candidates to achieve successful results (reduced nodules) by this treatment. Additionally, good candidates for the ablated thyroid procedure are individuals whose nodules are visible and causing pain in the neck region.

At this time, RFA is limited to nodules which are benign; however, the plan is that RFA may also become an option for individuals who have small thyroid tumors that are cancerous.

Benign Toxic autonomous thyroid nodule is the other subgroup of patients who could significantly benefit from Thyroid RFA instead of the conventional nuclear medicine, which can lead to permanent hypothyroidism.

Pregnant women should not undergo RFA treatment due to the electrical currents. For the same reason, patients with cardiac arrhythmia should stay away from this type of treatment.

This procedure is referred to as “minimally invasive and non-surgical”. To be classified as “non-surgical”, the procedure does not involve cutting and/or the removal of bodily organs and/or any tissue.

A topical anesthesia is applied to the skin to numb the localized area so that no pain is experienced. Additionally, a mild sedative maybe prescribed to aid in overall relaxation of the patient.

Individuals that have been surveyed said that they are relieved to have an option that is not surgery and will not require them to be on hormone medication for the rest of their lives.

The patient will be laying on their back and their neck will be extended slightly. A local anesthesia will be administered. A thin needle/probe is inserted into the nodule and radiofrequency energy (electrical currents) is passed through the tissue generating heat at the nodule site that will reduce the size of the nodule. The size of the nodule will affect the procedural time; however, on average the procedure should take about 30 minutes to complete.

The doctor will insert the needle guided by ultrasound and when the probe arrives at the target area, the radiofrequency generator is activated, and the procedure will begin. At the conclusion of the procedure, most (or all) of the nodule’s cells are dead, but because of the precision of this treatment, the healthy cells of the thyroid are not affected.

Thyroid ablation RFA is considered effective and successful when the nodule is reduced by 50% or more. On average, a solid thyroid nodule will shrink by 80% and in some cases, totally disappear. This non-surgical option has improved pressure and symptoms in benign thyroid nodules. Reports have shown positive results in reduction in nodules volume; cosmetic symptoms, and pressure symptoms. All results seem to be sustained on a long-term basis.

Most patients achieve positive results in only one RFA treatment session; however, there are a few patients that have very large thyroid nodules and they may require a second treatment to obtain the best results and prevent re-growth.

Not only is RFA effective on thyroid nodules, but it is also a safe and effective treatment for reoccurring cysts.

Results have been very positive. In fact, nodules have been reduced by up to 60% within the first 30 days and up to 85% within 6 months after the procedure. The majority of the reduction is observed with the first month and further reduction happens slowly in the following months.

One RFA complication may include voice alteration and/or hoarseness, but most patients regain their original voice a few months after the RFA treatment.

Skin burn is a minor complication that was also reported in very few cases. At the site of the puncture, skin may change color slightly and patients may experience minor discomfort. The skin heals on its own within 2 weeks of the procedure.

Nausea and/or vomiting may occur after the procedure, but never during the treatment. One of the causes of feeling nauseous is due to the extension of the neck which may cause an imbalance of blood flow, resulting in nausea and/or vomiting. Other factors contributing to this complication may include age, gender, non-smoker, and a history of nausea.

A very rare complication is a ruptured nodule. This complication will not be noticed immediately but it may appear several weeks later. Pain will occur at the site of the procedure and the neck will be suddenly bulging. Antibiotics will usually help to heal a nodule rupture.

There have been no fatalities, no permanent changes in voice, no tracheal injury, esophageal injury, or any other major (life altering) complications.

The recovery time is minimal – in fact, once the procedure is complete, patients can return to their normal routine within 24 hours. Extreme exercise can resume within 72 hours of treatment. Also, unlike other thyroid procedures, long term thyroid hormone medication may not be required. Keep in mind that patients who opt for standard thyroid nodule surgery and not RFA, will not be able to resume normal activities for several weeks, and about 25% will require medication for the rest of their lives.

RFA procedure cost varies depending on the state and/or location of the procedure. Any medical procedure conducted in a hospital setting will always be very costly. However, the great thing about RFA treatment cost is that sedation and hospitals are eliminated; therefore, costs are significantly reduced. The cost of this procedure varies based on each individual’s needs. The good news is that some insurances could cover some of the costs and your out-of-pocket expense will be reduced even further. The best solution would be to contact our office to make an appointment with Dr. Nikravan, and after his consultation, you will have a clear idea of your situation, your treatment options and costs.

Usually regrowth is not a concern because the nodule was benign and should not cause problems down the line. There are occasions when the nodule is in a hard-to-reach location and the entire nodule is not ablated. On the rare occasion that the nodule grows back and the patient once again becomes symptomatic, the RFA procedure can be repeated, or you can look into traditional thyroid surgery.

Some patients may experience mild pain in the neck area or an uncomfortable warming sensation. This pain/discomfort usually disappears quickly once the power output is reduced and/or the treatment ends. Some probable reasons behind the discomfort is parenchymal edema, thyroid capsule thermal damage, size of the needle, non-gentle handling of the needle, and lack of training/expertise.

To reduce any other discomfort, local anesthesia is highly recommended to prevent pain where the needle is inserted, and the electrode is being positioned.

No. Unlike traditional thyroid surgery, RFA does not leave a scar formation on your skin. Due to the fact thatthis procedure is minimally invasive and pin-pointed, there is no scarring.

RFA is a challenging procedure and requires a person extensively trained to operate the probe. The operator will have full understanding of the anatomy of the neck and the nervous system of the patient. All possible complications must be considered, and preventive measures should be in place.

There are several methods that an Endocrinologist Interventionalist should know to avoid nerve damage including the “moving shot technique” and the “transisthmic approach.”