Radiofrequency Ablation: An Alternative Approach to Treating Papillary Thyroid Cancer

The traditional approach to treating most forms of cancer, including papillary thyroid cancer, is surgery and removal of the affected tissues. While it can be an effective solution when the cancer hasn’t spread to other parts of the body, surgery is invasive, stressful, and can negatively impact your quality of life.

For example, removal of a cancerous thyroid gland can leave neck scars and alter your voice. It may also require you to take lifelong hormone medication, and, like all surgeries, it carries a risk of complications, such as infections.

Fortunately, a less invasive alternative is available to many papillary thyroid cancer patients: Radiofrequency Ablation (RFA). This treatment method does not require surgery, is quicker, has a shorter recovery time, and has fewer complication risks.

As an alternative treatment for papillary thyroid cancer, RFA offers numerous benefits to those who are eligible, from faster recovery times to fewer complications. Learn about the RFA procedure and determine whether it is the right treatment for you.

What is Papillary Thyroid Cancer?

Papillary thyroid cancer (PTC) is one of the four types of thyroid cancer. According to the National Institutes of Health (NIH), papillary forms of thyroid cancer are the most common, accounting for 80% to 85% of all cases. PTC is curable for most patients, especially those under 45.

PTC originates in the thyroid gland, an organ of the neck responsible for producing hormones that regulate heart rate, body temperature, digestion, bone density, and metabolism.

Papillary thyroid cancer can disrupt all of these processes and cause a wide range of health risks and complications, including:

• High blood pressure
• Heart conditions, such as arrhythmia or heart valve disease
• Osteoporosis
• Growth and metastasis of the cancerous cells
• Thyroid disruption, potentially resulting in hyperthyroidism or hypothyroidism

Common symptoms of PTC include the following:

• A small lump in the neck that isn’t painful to touch
• Difficulties swallowing
• Swollen lymph nodes near the thyroid
• Hoarse voice

Causes of Papillary Thyroid Cancer

Papillary thyroid cancer is most frequently diagnosed in adults between the ages of 30 and 50. While the exact causes are not fully understood, several risk factors have been identified that contribute to its development, including:

• Radiation exposure. People who have been exposed to ionizing radiation are at a higher risk of developing papillary thyroid cancer. This includes children who were exposed to head and neck radiation therapy, which was a popular method to treat certain benign diseases from the 1940s to the 1960s.
• Genetic factors. Patients with specific hereditary syndromes may be predisposed to develop papillary thyroid cancer, such as Gardner Syndrome, Werner Syndrome, and Type 1 Carney Complex. Additionally, 5 to 10% of papillary thyroid cancer patients have family members who also developed PTC.
• Other factors. Research has shown a slightly increased risk of developing papillary thyroid cancer among certain patients with pre-existing benign thyroid diseases. Another study has linked obesity as a possible additional risk factor.

However, many patients have no known risk factors that could help prevent the formation of PTC. Regular screenings and monitoring are the best solutions for most patients to detect and treat this form of cancer as early as possible.

How Does Radiofrequency Ablation Work?

A radiofrequency ablation (RFA) procedure uses radio waves and heat instead of surgical removal to treat and destroy cancerous cells. The entire procedure takes 15 to 60 minutes to complete, depending on the size and location of the affected area. Here’s a step-by-step breakdown of how it typically works:

• Locating and targeting the tumor. The procedure begins with ultrasound imaging of the throat. A complete view of the thyroid nodule allows healthcare providers to locate the tumor or cancerous cells, which is necessary to complete the rest of the procedure.
• Local anesthesia and needle insertion. Once the area to target has been identified, your doctor will apply a local anesthetic to the neck, ensuring the next step causes no or minimal pain. After anesthesia, they will insert a thin needle electrode into your neck and directly into the thyroid nodule. Ultrasound imaging helps guide the insertion process, ensuring it is precisely guided to its target without damaging other organs or structures in the throat, like the trachea or larynx.
• Heat generation. After ensuring it is correctly positioned, caregivers will turn on the generator connected to the needle. This allows radiofrequency energy to start flowing through the needle. It generates heat at the needle’s tip, reaching temperatures of over 200°F.
• Cancerous tissue destruction. When the needle heats the cancerous tissue, it causes the abnormal cells to break down and burn away before the cancer can spread. This method quickly kills the targeted cancer cells but is accurate enough not to damage the surrounding healthy tissue. Most of the RFA procedure is spent in this phase, often requiring 20 minutes or more to complete.
• Continuous monitoring. Doctors and radiological staff will remain with you and monitor every aspect of the procedure from start to finish. They will control the energy and temperature the needle generates and observe its effects in real-time with ultrasound imaging, ensuring only the affected area is treated.
• Communication and feedback. Staff will also communicate with you and provide feedback and reassurance. While most patients can talk during an RFA procedure, local anesthesia may affect your ability to speak clearly, depending on the tumor’s location.
• Conclusion and follow-up. Once the procedure is over, your doctor will closely monitor you for signs of adverse reactions, such as swelling or bleeding. You may also feel some pain or discomfort in the treated part of the throat; it is normal, and you may be prescribed OTC pain medication to manage it.
  Your healthcare provider may advise you to rest for the remainder of the day and avoid driving on the way back home, especially if you still feel dizzy or numb from the anesthetic. In the days following the procedure, you may be advised to avoid intensive exercise or activities, such as bending or heavy lifting.

Who is Eligible for Radiofrequency Ablation?

While RFA can be a suitable alternative treatment for papillary thyroid cancer to surgery, your eligibility depends on multiple factors. Specialized healthcare providers, such as endocrinologists, can assess your suitability for the procedure based on the following factors:

• Tumor size. The RFA procedure is most effective in cases with small cancerous nodules, typically less than 1 cm (about 0.39”) in size. Your doctors may recommend a different method if your tumor is larger or if you have multiple tumors.
• Tumor location. Doctors may recommend against RFA if your tumor is close to critical structures in the throat, such as your esophagus, vocal cord nerves, or a major blood vessel. The procedure could damage them and create serious health complications.
• Cancer stage. RFA is most effective in patients whose thyroid cancer has not spread to other body parts. If your cancer has metastasized beyond the thyroid gland, you may be recommended different, more potent treatment and management methods, such as surgery, radioactive iodine therapy, and chemotherapy.
• Pre-existing health conditions. Pregnant people and patients with pacemakers are generally ineligible for RFA. Doctors may also recommend against RFA if they believe your overall health could compromise your ability to tolerate the procedure.

Radiofrequency Ablation as an Alternative Treatment for Papillary Thyroid Cancer

The RFA procedure is a proven alternative treatment for papillary thyroid cancer under the right circumstances. It offers patients numerous benefits and quality of life improvements over traditional methods, such as surgery.

• Minimally invasive. Unlike traditional surgery, which requires opening the throat and operating directly on the thyroid, RFA only requires ultrasound imaging and the insertion of a needle into the affected area. It reduces the operation’s length, shortens recovery time, and offers an option for patients who can’t or don’t feel comfortable with surgery.
• Preserves thyroid function. Traditional thyroid cancer surgery involves either a partial or a total thyroidectomy. This means that the thyroid gland is either cut to remove the cancerous part or removed entirely. Both options reduce or eliminate thyroid function, requiring the patient to take thyroid hormone replacement medications for the rest of their lives.
  RFA is more precise and preserves as much healthy tissue as possible, with a lower risk of damage to healthy tissue. Compared to an equivalent surgery, a successful RFA operation is more likely to leave the thyroid functional, reducing or eliminating the need for hormone therapy.
• Fewer complication risks. All surgeries carry inherent complication risks, such as infection, bleeding, or unintentional damage to healthy tissue. Even a successful procedure can leave neck scars. These risks are much lower with the RFA procedure, making it safer overall.
• More flexible. If your thyroid cancer returns after an initial RFA treatment, the procedure can be safely repeated as many times as necessary. It can be combined with other treatments and therapies, depending on your doctor’s recommendations. Thyroid surgery is rarely performed more than once, as the risks of complications multiply with each operation.

Potential Risks and Complications Associated with Radiofrequency Ablation

While the radiofrequency ablation procedure is generally safer and results in fewer complications than traditional open surgery, no treatment is 100% risk-free. A 2024 study has evaluated the types of treatment complications and compiled a list of incidence rates.

If you choose radiofrequency ablation to treat papillary thyroid cancer, some of the main potential risks and complications to be aware of include:

• Pain. The most common complication after undergoing an RFA procedure is lasting pain caused by the insertion of a needle, with an incidence rate ranging between 0.8% and 15.7%.
  Pain is expected to go away spontaneously within one to two days and can be managed with common over-the-counter medication. Consult a medical professional if post-procedure pain lasts for more than three consecutive days or is intolerably intense.
• Fever. A small number of patients may feel feverish after the operation, with an estimated incidence rate of up to 6%. However, most episodes of fever after an RFA procedure rarely exceed 100°F and typically resolve within 36 hours.
• Post-operative bruises. Hematoma, or bruises, are relatively rare side effects (up to 2.1% incidence rate) following an RFA operation. The surface of your skin around the area penetrated by the needle may appear darker and feel softer due to a small accumulation of blood under the surface.
  Most cases resolve within one to two weeks with appropriate daily treatment, such as mild compression of the affected area for five to ten minutes.
• Nausea, vomiting, and vasovagal reactions. Post-operative nausea and vasovagal reactions (lightheadedness, fainting) are rare but well-known potential risks of many procedures, including RFA. The incidence rate of nausea among RFA patients is up to 0.62%, whereas vasovagal reactions (when heart rate and blood pressure suddenly drop) reach up to 0.34%.
  If you are prone to these reactions, your doctor may recommend preventative medicine, such as antiemetics.
• Nodule ruptures. One of the most severe risks of an RFA procedure is the possibility of a thyroid nodule bursting or breaking down. It typically occurs if the amount of radio energy used or the needle tip temperature is too high. The reported incidence rate of a nodule rupture ranges from 0.19% to 2.5%.
  Nodule ruptures must be carefully and closely monitored. Typical management methods include anti-inflammatory medications and antibiotics. In severe cases, a nodule rupture may require surgical intervention.
• Voice changes. Laryngeal nerve palsy is one of the most severe potential risks of the RFA procedure. This condition can alter the patient’s voice and can be detected through hoarseness or changes in vocal tone.
  This complication is extremely rare and typically associated with operating on tumors located too closely to the vocal cords. Most cases are temporary and resolve on their own within two to three months. However, a small number of cases may experience permanent voice changes. Contact a medical professional if hoarseness lasts more than three months after your RFA operation.

Effectiveness of Radiofrequency Ablation in Treating Papillary Thyroid Cancer

Although radiofrequency ablation is a relatively new solution to treat papillary thyroid cancer, research has demonstrated that it is not only safer than traditional surgery but also highly effective.

A 2022 systematic review of radiofrequency ablation treatments for papillary thyroid cancer found that RFA is:

• Highly effective. 79% of RFA procedures resulted in a complete disappearance of tumor or cancer tissue. It indicates the procedure is generally very effective at removing affected tissue.
• Low repetition rate. Only 50 tumors required multiple RFA procedures; 49 required one additional session, and just one required two. These numbers show that a single procedure is effective at treating most tumors.
• High long-term survival rate. Patients who were diagnosed with PTC and treated with RFA have a disease-specific survival rate of over 99% after ten years of follow-up. This indicates that RFA is safe in the long term, with no expected complications years down the line.

Book Your Appointment with Associated Endocrinologists

Research has demonstrated that radiofrequency ablation is a safe and effective alternative treatment for papillary thyroid cancer. If you were diagnosed with PTC, contact the team at Associated Endocrinologists. We can help you interpret your diagnosis or imaging results, review your health history, and determine whether RFA is a suitable option for you.

If you choose to undergo the RFA procedure, our skilled medical team can perform the treatment and provide the post-procedure care and appointments you need.