What is Thyroid Ablation?
Radiofrequency ablation is a minimally-invasive procedure for treating conditions of the thyroid gland. It is an effective alternative to thyroid surgery with a high success rate and a faster recovery.
The treatment uses intense targeted heat to destroy pathogenic tissue while leaving healthy thyroid gland tissue intact. This improves thyroid function and enhances your quality of life.
What Conditions Does Thyroid Radiofrequency Ablation Treat?
Before your doctor prescribes thyroid radiofrequency ablation, they need to perform a manual exam of your neck to palpate the thyroid gland to feel for the presence of nodules. They also perform a thyroid ultrasound to confirm the nodule diagnosis and determine its type, size, and location.
The most common conditions treatable by thyroid nodule RFA include:
- Benign thyroid nodules evaluated using a biopsy
- Predominantly solid thyroid nodules that cause neck pain
- Benign thyroid nodules that obstruct the airway or esophagus, making it challenging to breathe, swallow, or speak
- Benign thyroid nodules that cause cosmetic problems
If you have thyroid nodules that are predominantly cystic or fluid-filled, your doctor may recommend an alternative treatment such as alcohol ablation.
Who is Ineligible for Thyroid RFA?
Thyroid RFA is a safe and effective treatment for benign thyroid nodules supported by the American Thyroid Association. However, the following conditions may exclude you from receiving treatment.
- Patients who have had previous neck surgery: Damage to the vocal cords or excess scar tissue can make it challenging for the electrode needle to access the thyroid nodules and may result in incomplete ablation.
- Pregnant patients: Most types of thyroid treatment, including RFA and radioactive iodine therapy, are contraindicated for pregnant patients as hormonal changes and radiation can impact fetal development. However, between 5 and 40% of nodules discovered during pregnancy indicate malignant thyroid disease or cancer and should be monitored carefully by a qualified endocrinologist.
- Patients with heart disease: If you are fitted with a pacemaker or defibrillator to treat severe heart disease or congenital conditions, you may not be eligible for thyroid RFA. The high-frequency pulses and generator may disrupt these devices’ functioning.
- Patients with biopsy-confirmed malignant thyroid conditions: If you have been diagnosed with malignant thyroid conditions such as papillary, follicular, medullary, or anaplastic thyroid cancers, RFA is not a suitable treatment. Your doctor may prescribe neck surgery like a thyroidectomy or radioactive iodine treatment for the management of thyroid cancer.
- Patients with small or asymptomatic nodules: If your nodules are small and do not impact your quality of life, your doctor may suggest monitoring their growth.
The Thyroid Radiofrequency Ablation Procedure
At your preprocedural evaluation, your doctor will suggest you stop any blood thinning medications like warfarin or heparin for several days before the procedure. You should also wear light, loose clothes and avoid wearing jewelry on the day of treatment.
When you arrive, you’ll change into a hospital gown and lay down on the exam table. The doctor will place a pillow behind your head for neck support. They’ll also place grounding pads on your thighs that are connected to the RF generator.
Your doctor will apply a numbing gel to your neck above the thyroid gland. They’ll inject a local anesthetic into the site to numb the area so you won’t feel the electrode needle when inserted. They also apply lubricating jelly to your neck to allow the ultrasound transducer wand to glide smoothly over your skin; ultrasound-guided ablation procedures increase precision and safety.
Once the needle is inside your neck, you may feel slight pressure, but you should not feel any pain as the thyroid gland does not have nerve endings.
After inserting the electrode, the doctor activates the RF generator, which sends an alternating current through the needle, heating the tip. The doctor continuously moves the needle around your neck to ensure the entire nodule is ablated, preventing healthy thyroid tissue from overheating.
After removing the needle, your doctor applies an adhesive bandage to the entry wound.
Thyroid RFA Aftercare
Since thyroid RFA is a non-surgical procedure, you may resume your normal activities almost immediately after treatment. However, to minimize any complications, it is important to follow your doctor’s instructions for post-procedural management and wound care, including:
- Changing wound dressings daily and keeping the site dry for at least 24 hours
- Using OTC medications for pain relief
- Applying an ice pack intermittently for 15 minutes on and off to manage swelling
Minor swelling, bruising, and tenderness around the insertion site are normal for several days following treatment. However, if you experience nausea, fever, or your symptoms worsen, contact Associated Endocrinologists immediately for a follow-up appointment.
You’ll need to schedule follow-up appointments at six weeks, six months, and twelve months so your doctor can evaluate your progress, monitor the shrinking nodules, and check for potential side effects or complications.
Thyroid RFA Success Rate
Ablation has been used for decades to alleviate joint and nerve pain and treat varicose veins. The application of ablation technologies for thyroid issues has proven successful in both clinical and non-clinical settings.
Thyroid RFA is FDA-approved and is performed at numerous prestigious academic institutions across the country, including Columbia, Stanford, and Johns Hopkins. Thyroid RFA has been successfully performed in Europe and Korea for over a decade and is approved by the Korean Society Of Thyroid Radiology.
Studies have shown that following RFA treatment, nodules can shrink by up to 84.6%, although larger nodules or multinodular goiters may need a repeat treatment to achieve full ablation. A 2021 study showed that ablated nodules had decreased in volume by 95.65% after 24 months, and thyroid hormone levels had normalized to within the normal range for each patient’s age group.
Research continues to demonstrate that thyroid RFA is an effective treatment for benign nodules and a suitable alternative to a surgical procedure to remove damaged tissue.
Possible Side Effects of Thyroid Ablation
RFA treatment has a low risk of severe complications and long-term side effects. However, in some rare cases, patients report transient complications that typically resolve within one to two weeks, including:
Discomfort During the Procedure
Approximately 2% to 3% of patients experience discomfort when the electrode needle is inserted into the thyroid gland. Your doctor can manage any discomfort by increasing the local anesthetic dosage.
Minor Skin Burns
The electrode needle heats to between 122°F and 212°F, and the edges tend to heat faster than the center of the electrode. 122°F is hot enough to damage nodule tissue and cause necrosis, but minor skin burns can also occur. In a 2017 study of 3,409 participants, six cases sustained mild skin burns.
Decreased Heart Rate
During RFA, the doctor may accidentally stimulate the Vagus nerve causing a slow heart rate or faintness. This side effect typically resolves immediately once the procedure is complete.
Vocal changes are an extremely rare side effect of RFA; only 0.94% of patients report a temporary change, while 0.17% report a permanent change in the sound of their voice.
A nodule can rupture if the tip of the electrode causes a puncture. Only 0.17% of patients report a nodule rupture during thyroid RFA. A nodule rapture can also lead to transient thyrotoxicosis. This condition occurs when excessive amounts of thyroid hormone are in the blood. However, research suggests that the condition typically resolves within 30 days.
Because the procedure is minimally invasive, the risk of infection due to RFA is minimal. The electrode’s small size and the sterile environment minimize the risk of infection from RFA.
Hypothyroidism occurs when the thyroid doesn’t produce adequate amounts of thyroid hormones. Symptoms of hypothyroidism include irregular periods in women, low sperm counts in men, mood changes, and weight fluctuations. This side effect is more often caused by thyroid surgery; however, if your thyroid function is damaged during RFA treatment, it may cause your TSH levels to drop, and your doctor may prescribe thyroid medication.
RFA doctors use specialized techniques to reduce the risk of nerve damage due to RFA, including a transichemic approach and the moving shot method.
However, due to the dense nerve bundles in the head & neck and the location of major nerves like the vagus nerve, brachial plexus nerve, and laryngeal nerve, there is a minor risk of damage. Nerve damage can cause numbness in the extremities and face and vocal changes.
Benefits of Thyroid RFA vs. Surgery
Although both ultrasound-guided ablation procedures and neck surgery are effective for removing benign nodules, RFA offers several benefits over surgical procedures:
- Minimal scarring
- The outpatient procedure requires no hospital stay
- Healthy thyroid tissue is not damaged during RFA, reducing the need for hormone replacement therapy
- RFA has a high success rate with a low risk of post-procedural complications
- No need for general anesthesia
- Short recovery time