Radiofrequency ablation (RFA) is a non-surgical procedure that has been approved by the FDA for the treatment of benign thyroid nodules. It reduces nodules without compromising thyroid function and helps prevent long recovery times from thyroid surgery. The procedure is performed by inserting a needle-like probe into the thyroid nodule, and the tip of the needle heats up, destroying the nodule from the inside and causing it to shrink. Studies have shown that RFA is a safe and effective treatment for benign thyroid nodules, and it has been used extensively in Asia, Europe, and South America.If you have symptoms of thyroid nodules but don't want surgery, you may be a candidate for RFA and should discuss this with your endocrinologist.
In general, any patient with a benign nodule who is a candidate for surgery might consider RFA. This includes patients with symptoms or aesthetic problems caused by a growing nodule, and those who have a toxic nodule (i.e. a nodule that produces too much thyroid hormone). Patients who are unable to have surgery safely, such as those who cannot undergo anesthesia, may also consider this treatment.
Patients whose nodules are filled with fluid (cystic) don't do as well with radiofrequency ablation; instead, we can offer alcohol ablation, also known as percutaneous ethanol injection, to drain the nodule and inject it with alcohol, causing the nodule to shrink over time. Before the RFA, you will need two separate biopsies to verify that the nodule is benign. Your endocrinologist may perform a biopsy in the office if you haven't had one before. You may need a biopsy even if you are considering surgery for your thyroid nodule. Currently, RFA is only approved by the FDA in the U. S., but in Europe and Asia doctors also use it for cancerous thyroid nodules.
In the future, we hope to become a research site for the treatment of cancerous thyroid nodules with RFA. The procedure is performed under local anesthesia, with the option of mild to moderate sedation (IV medication), which will help you stay calm, comfortable and consistent. It is important that you talk to your endocrinologist during the procedure to ensure that the vocal cords are not affected. Under ultrasound guidance, the doctor will insert a thin needle into the nodule through the skin. We use a parallel approach, which means we can see the entire needle throughout the procedure, reducing the risk of complications.
This is the same technique we use to perform fine-needle aspiration (FNA) thyroid nodule biopsies: we perform hundreds of FNA biopsies in our clinic every year without complications. The needle is connected to a generator that uses electricity to generate heat around the tip of the needle. The doctor will move the needle back and forth into the nodule and remove (burn) it from the inside. Normal thyroid tissue will not be affected. The removed tissue will develop into scar tissue over time, causing the nodule to begin to shrink. After the procedure, you can rest while the effect of the sedative wears off.
Most patients can go home the same day; you'll have to arrange for someone to take you. Studies have shown that patients can expect their nodules to be reduced by 50-97%. Patients usually have a maximum reduction within the first four weeks after RFA; the nodule will continue to shrink for the next six months to a year. As the nodule shrinks, symptoms will decrease. Your endocrinologist will monitor your progress using an ultrasound scan.
The chances of the nodule growing back are very low, but it can happen; in that situation, treatment may be repeated or you may choose to have surgery. The complications of RFA are similar to those of surgery, but occur at a slower rate. Risks include vocal cord paralysis, bleeding, hoarseness of voice, infection, and damage to surrounding structures in the neck. A potential drawback is that RFA may not be covered by insurance because it is so new; radiofrequency ablation currently has out-of-pocket costs, and doctors are working nationwide to encourage insurers to cover this procedure in the future. If you need or want this procedure, UT Southwestern's patient services can help you navigate resource options. If you're thinking about having surgery or other treatment for benign thyroid nodules, talk to an endocrinologist; we can help you compare your options to find the least invasive and most effective treatment for your condition.
To visit an endocrinologist, call 214-645-8300 or request an appointment online.
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