Radiofrequency ablation (RFA) is a minimally invasive treatment option that can reduce the size of thyroid nodules and restore thyroid function. It is a procedure performed by an endocrine surgeon guided by ultrasound images, which emits targeted radio waves that alter the cells in the node, causing them to shrink as the removed tissue is absorbed by the body. RFA is done in the office or in an outpatient setting with local anesthesia, meaning you will be awake but feel no pain. Any patient with a benign nodule who is a candidate for surgery might consider RFA, including those with symptoms or cosmetic problems caused by a growing nodule, those with a toxic nodule (i.e., a nodule that produces too much thyroid hormone), and those who cannot safely undergo surgery such as those who cannot undergo anesthesia.
The overall complication rate of RFA is 2.38%, with 1.35% for major complications. A systematic review and meta-analysis concluded that the reduction in thyroid nodule volume is already evident 6 months after ARF and that early results remain stable over time. The goal is to treat these nodules in a single ARF session; however, very large nodules or nodules that are not well controlled by one treatment may require additional RFA treatments to achieve optimal size reduction. Despite the fact that monopolar ARF has its own theoretical drawback, the promising bipolar RFA is not yet applied in the clinic today.
Studies to date suggest a low rate of serious complications and a small need for thyroid hormone replacement after ARF. A recent systematic review and meta-analysis concluded that curative success of ARF for locally recurrent thyroid cancer is 100%, with serum thyroglobulin decreasing by 71.6%. However, you may not be a candidate for RFA if your thyroid nodule is close to critical structures such as the nerve in the vocal cords, esophagus, or major blood vessels. Larger randomized studies could demonstrate the long-term effectiveness of ARF compared to surgery for the first-line treatment of thyroid cancer. This could provide more evidence on whether RFA can be used to treat thyroid cancer.