What is Thyroid Radiofrequency Ablation?

3D Animation Thyroid Radiofrequency Ablation Soft Tissue

An Overview of Thyroid Radiofrequency Ablation

 

We are here to help guide you through your journey of considering a new preferred method of treatment for benign thyroid nodules. Thyroid Radiofrequency Ablation treatment was developed over fifteen years ago. This minimally invasive, non-surgical alternative shrinks the nodules without compromising thyroid function and helps avoid the long recovery times of other types of thyroid surgery.

Thyroid Radiofrequency Ablation therapy is backed by science, years of clinical data, and incredible success stories. 

We have put together a comprehensive list of sources for you to look through. Let’s begin…

How Does It Work?

A numbing injection and/or cream will be applied to the skin near your nodule. Then, using ultrasound guidance, a thin-gauge needle is inserted into the neck using the nodule as the target location. Your doctor then carefully and methodically maps out and destroys the nodule using a radio frequency that is concentrated at the tip of the needle.

The radiofrequency agitates the structure of the cells in the unwanted nodule. That agitation creates thermal heat which destroys the tissue. While this is a painless procedure, you’re likely to feel some pressure and/or mild discomfort.

The entire process takes 30-60 minutes from start to finish. After a short evaluation period, you’ll be free to go home. Follow-up care typically includes an ice pack and an over-the-counter pain medication.

 

How Long Does It Take To Notice Results?

You will start noticing the biggest difference in the first 1-3 months following your procedure. Your nodule may continue to shrink over the next 36 months, but most reduction occurs within the first 12 months as your body rids itself of the damaged tissue.

Are You A Good Candidate for Thyroid RFA?

Non-surgical candidate

  • Whether you have contraindications or just prefer to avoid surgery and/or general anesthesia – thyroid RFA is a great option for you!

Cosmetic concerns

  • When the nodule is so big it is visible from the outside of the neck – thyroid RFA can help!

Compressive symptoms

  • When dealing with the feeling of something in your neck, difficulty swallowing, breathing, and/or voice change – thyroid RFA can make those symptoms disappear!

Thyroid RFA can also help patients dealing with:

  • Toxic nodules: hyperfunctioning nodules or hyperthyroidism
  • The possible development of multinodular goiter
Will your doctor approve you for this type of treatment?

The type of nodule(s) and individual patient scenarios help determine which patients should consider Thyroid RFA therapy.

Discussing this treatment with your doctor is the best way to know for sure if you qualify for this procedure, but the following are typical requirements for RFA therapy:

  • Two negative fine-needle aspirations (FNA) biopsies OR one negative core-needle biopsy
  • You must be clear of having any type of thyroid cancer
  • Be able to stop any type of blood-thinning medication or supplements prior to the procedure
  • Nodules with a volume greater than 2ml

Sometimes internal devices, such as a pacemaker, can disqualify you from the therapy. As with any procedure, be sure to discuss it with your doctor.

What are the possible complications?

In a clinical study, observing 505 patients (539 Nodules), only 3.3% experienced complications, including:

  • Hematoma or bruising:
    • 0% (usually disappears within 1-2 weeks)
  • Temporary voice change:
    • 94%. (recovery time of 1-90 days)
  • Vomiting:
    • 6% (1-2 days post-procedure)
  • Minor Skin Burn:
    • 14% (resolves within one week)
  • Hypothyroidism:
    • 07% (medication needed, similar to what would be needed following a thyroidectomy)
  • Infection/abscess formation:
    • 07% (surgical cleanup could be necessary to resolve this incredibly rare issue)
  • Life-threatening complications:
    • NONE REPORTED

Other nerve damage possible, although exceedingly rare

How Effective is this Procedure?

Clinical trials measured the rate of reduction, therapeutic success, changes in symptoms, and the cosmetic improvement of benign thyroid nodules.

For “cold” benign nodules (those that do not produce excess thyroid hormone), clinical trials have shown a mean reduction rate of 32.7 to 58.2% at one month, and 50.7 to 84.8% at six months. In most patients, nodule-related symptoms and cosmetic problems also significantly improved or disappeared. In a long-term follow-up study, radiofrequency ablation was effective over a four-year period with the nodules consistently decreasing to 93.5%.

For “hot” benign thyroid nodules (those that do produce excess thyroid hormone) clinical trials have shown volume reduction rates of 52.6 to 70.7% at six months, and improved or normalized thyroid function in most patients. In a multi-center study, hyperthyroidism caused by “hot” nodules improved in all patients and was completely normalized in 81.8% of patients. This led to the conclusion that radiofrequency ablation can be considered an alternative to thyroid surgery or radioactive iodine therapy.

When Is Surgery Preferred Over Thyroid RFA?

Sometimes RFA therapy is not the best option.

In these scenarios, surgery would be the preferred course of action:

  • Pregnancy
  • Internal implantation devices such as a pacemaker may complicate the RFA procedure at this time. Be sure to consult your physician with questions.
  • Most of the time, thyroid cancer is a contraindication for RFA. Although there are experimental types of RFA involving papillary and follicular thyroid cancer1, full resection of the thyroid gland is preferred for a multitude of reasons in this case. Be sure to consult your doctor for further information.
An Easier Option?

A common practice in other countries, radiofrequency ablation (RFA) is now available in the United States. Developed over fifteen years ago, this non-surgical alternative shrinks the nodules usually without compromising thyroid function and helps avoid the long recovery times of thyroid surgery.

Radiofrequency ablation of the thyroid was popularized by Professor Baek in South Korea and has since been continuously adopted by many medical practitioners.

Worldwide, approximately seven thousand procedures are performed each year in just a few facilities.

What To Expect During The Procedure

You will be able to breathe, swallow and talk normally the entire time. Two grounding pads will be attached to your thigh. Your neck will be cleaned and head will be placed on a small cushion with your neck extended. The doctor will give you pain medication in the area of the thyroid.

The doctor will ask you several times during the treatment how you are doing and whether you feel pain, and can easily give you more if you are uncomfortable at any time.

Preparing for Radiofrequency Ablation

Radio-frequency ablation takes place in an outpatient setting. Although you will not be under general anesthesia, you will need to follow some pre-procedural instructions from your healthcare facility. They will review the list of your current medications and provide instructions.

In most cases, your medications will not affect the procedure. If you take medication for diabetes or high blood pressure, you will most likely be instructed to keep taking it. If you’re on blood thinning medication, you will probably need to stop taking it for a few days prior to the procedure. Be sure to inform your physician if you have a pacemaker, implants, are pregnant, or on any medication (especially for blood thinning). Don’t wear makeup, lipstick, or any metal jewelry on the day of the procedure.

Advantages Of Radiofrequency Ablation Of Thyroid Nodules

Compared with surgery, the primary advantages of radiofrequency ablation are:

  • The potential for fewer complications
  • Generally shorter recovery time with a quick return to normal activities
  • Increased likelihood of preservation of thyroid function.

The entire procedure takes between fifteen minutes to one hour. Because it is minimally invasive and does not require general anesthesia, you avoid the external scarring of traditional thyroid surgery, and the associated risks of anesthesia. Radio-frequency ablation may also minimize the risk of permanent damage to the vocal cord nerve or to the parathyroid glands.

One of the most meaningful long-term advantages is that you may not need to take lifelong thyroid medication. The treatment preserves healthy thyroid tissue, which allows the thyroid to continue functioning normally — no ongoing medication management, with the difficulties of achieving the correct thyroid hormone dosage.

Radio-frequency ablation is highly effective for benign thyroid nodules. Depending on the type (solid vs. fluid filled vs. a combination of the two), nodules shrink anywhere between 60-90% after one year, with approximately 80% on average

How Long Does The Procedure Last?

While the procedure itself takes less than an hour, the entire process may take 2-3 hours. Pre-procedural care and post procedural monitoring takes an additional hour. When the procedure is complete, a small bandage will be placed on the treatment site and the neck may be cooled with ice packs.

How Many Treatments Are Necessary?

For most nodules less than 4 cm, one treatment will sufficiently decrease the size of the nodules and improve symptoms. When nodules are close to vocal cord nerves, or with very large nodules, repeated procedures may be necessary. Untreated areas of “hot” nodules may interfere with the improvement in thyroid function. In these instances, complete ablation may be required. For this reason, more than one treatment session may be necessary to successfully treat “hot” nodules.

Are There Any Side Effects?

In a multi-center study of 1459 patients organized by the Korean Society of Thyroid Radiology, the overall complication rate following radiofrequency ablation was 3.3%. The major complication rate was 1.4%. While uncommon, complications can be:
• Temporary voice changes, such as hoarseness.
• Slight bleeding — usually disappears on its own within one day, or at the most, up to three months.
• Wound infections
• In rare cases, vomiting, coughing, or seared skin at the treatment site may occur

• Patients with AFTN (“hot” thyroid nodules) have the possibility of hypothyroidism after the procedure. Although rare, a complication may require an inpatient hospital stay or follow-up treatment.

Is There Any Follow-Up Care?

Following radio-frequency ablation, your physician may monitor the treated nodules with ultrasound scans or lab tests.

Is This Procedure Reimbursed By Insurance?

Although this procedure is FDA cleared, at this moment in time it is a cash based procedure.

The cost will be provided by your provider and/or institution.However, as a patient you have the right to submit to insurance for reimbursement after the procedure has been completed. Your physician’s office can help guide you in this process.

Leading Edge Option For Benign Thyroid Nodules

In the final analysis, radiofrequency ablation (RFA) is an exciting alternative for patients who experience problems from benign thyroid nodules— offering the potential for less pain, less downtime and less external scarring than with surgery and without the risks of RAI. It is a safe and validated procedure that is now approved in the United States.

With its long lasting effects, radiofrequency ablation is a breakthrough in treating the symptoms of thyroid nodules.
Ultimately, your physician can help determine the most effective treatment option for you.

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The thyroid gland is small but it has a big job to do for your body. While it’s primarily responsible for controlling your metabolism, it ultimately affects nearly every part of your body. Just like a car battery, we do not usually think about it, until it stops working properly. 

 

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