Thyroid disorders are a common health concern, affecting an estimated 200 million people globally. In the United States alone, roughly 20 million Americans have some form of thyroid disease, according to the American Thyroid Association. Thyroid nodules are an example of such thyroid conditions.
Thyroid nodules are abnormal growths within the thyroid gland, which is located in the neck. They can be solid or fluid-filled and are often detected during routine medical examinations or imaging studies. While most thyroid nodules are benign (non-cancerous) and therefore do not require medical intervention, sometimes the nodules can get quite large and cause discomfort or cosmetic concerns. In that case, medical intervention—often thyroid surgery—may be required.
However, owing to the emergence of an alternative treatment option which is less invasive and presents a faster recovery rate, surgery can be avoided. This procedure is known as radiofrequency ablation (RFA). In this article, we will discuss what RFA is, how it works, its applications in thyroid health, its benefits, and potential risks.
What is radiofrequency ablation and how does it work?
Radiofrequency ablation is a medical technique that uses high-frequency electrical currents to heat and destroys abnormal tissues, such as tumors. This procedure is particularly effective in treating solid tumors that are located in various organs, including the liver, kidneys, lungs, and thyroid. In the context of thyroid health, RFA is primarily used for the treatment of benign thyroid nodules.
Before recommending RFA, healthcare professionals perform a comprehensive evaluation of the patient. Typically, prior to the RFA procedure, a preliminary assessment of the nature of the thyroid is performed by means of a fine-needle aspiration (FNA) biopsy with the help of ultrasound imaging.
Once the nodule’s benign nature has been confirmed, the procedure may be recommended. In order to control pain and movement during the procedure, RFA can be carried out on a patient under general anesthesia. However, this medical procedure is mostly performed under local anesthesia.
A needle-like probe is inserted into the thyroid nodule, with precise placement confirmed by ultrasound imaging. The probe is equipped with radiofrequency energy-emitting tips which heat up and destroy the nodule from the inside and shrink it as a result.
After RFA, patients are observed for a short period, after which they can return home the same day. This is because RFA is an outpatient procedure. Some individuals may experience mild discomfort or swelling, but this is temporary.
Applications of RFA in Thyroid Health
RFA is primarily used to treat benign thyroid nodules that cause symptoms such as having difficulty swallowing and breathing, or cosmetic concerns. It can help reduce the size of these nodules or make them disappear altogether.
It can also be considered for patients with multinodular goiter (an enlarged thyroid with multiple nodules) who are not candidates for surgery. The results of a study published in the World Journal of Surgery in 2022 suggest that ablating multiple nodules in a multinodular goiter within one session is just as effective and safe as ablating a single thyroid nodule in one session.
RFA is, however, not the only minimally invasive technique for destroying thyroid tissue. Other techniques such as ethanol ablation are more appropriate if the thyroid nodule is fluid-filled and not solid.
Benefits of RFA for Thyroid Nodules
Although a relatively new procedure, RFA is tried and tested. Several studies have examined the efficacy of this treatment technique. One of such is a comparative study in Italy whose findings, published in the journal Thyroid in 2020, demonstrate the long-lasting reduction in the size of benign thyroid nodules by RFA. Also, according to the study, the risk of requiring re-treatment after RFA is significantly low.
RFA also reduces the risk of developing hypothyroidism as compared to surgery (thyroidectomy) and radioactive iodine (RAI) therapy. Other benefits include:
- faster recovery
- no scarring
- no need for lifelong thyroid hormone replacement medication
- a very low complication rate
- cosmetic improvement due to the shrinking of the nodules
- improvement in quality of life through the elimination of symptoms caused by the nodules
Risks and Considerations
RFA for thyroid nodules is safe and well-tolerated. Possible major complications such as nerve injury and nodule rupture are a rarity.
Possible minor complications include skin burns, pain and other temporary side effects. Some patients may experience voice changes or discomfort in the neck, which usually resolve within a few days. In extremely rare cases, the change in the patient’s voice can be permanent.
There is also the risk of bleeding or infection, especially at the point of insertion of the probe. This is, however, also a very rare occurrence.
It is important to note that RFA is not suitable for every case of thyroid nodules. For instance, pregnant women should not undergo RFA. Similarly, people with a nodule that turns out to be malignant (cancerous) and larger than 1 cm should also not undergo RFA. For such a case of a malignant nodule, a thyroidectomy is the most appropriate treatment option.
- Radiofrequency ablation has emerged as a valuable and minimally invasive treatment option for thyroid nodules, offering patients a way to address discomfort, cosmetic concerns, or thyroid function issues without the need for surgery.
- RFA uses heat to destroy the thyroid tissue. The heat is generated by the passage of electric current through the target (thyroid) tissue.
- RFA is an outpatient procedure, which means that you should be able to go home the same day you undergo the procedure.
- Benefits include faster recovery, no scarring and no need for lifelong thyroid hormone replacement medication.
- This procedure may not be appropriate for all thyroid nodules. Patients should therefore discuss their specific case with a healthcare professional to determine whether RFA is a suitable option.