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  • How many days of work will I miss?
    On the day of the treatment we do not advise returning to work. The day after your therapy you may return to work or moderate exercise.
  • How many treatments are required for successful ablation?
    In patients who have one sided disease less than 75 ml of thyroid nodule volume, one treatment is very successful. For safety reasons, depending on nodule volume, patients who have two sided disease will require two separate treatment sessions. Patients who have disease greater than 75 ml have a higher chance that a second RFA treatment 12-24 months in the future may be necessary to completely destroy the target lesion. They may elect to undergo surgery as an alternative to RFA.
  • Is anesthesia required?
    A wide-field cervical nerve plexus block is performed with a local anesthetic. Local anesthesia is placed under US guidance to effectively numb the nerves of the anterior neck and capsule of the thyroid. Because the inside of the thyroid gland has no sensation, the treatment can be performed with little pain. During RFA treatments we speak the patients to ensure that they are comfortable and that their voice remains normal. General anesthesia is less desirable because the patient cannot speak. Under local anesthesia, we are still able to converse with the patient to assess the quality of the voice. Although rarely necessary, interventions to protect the recurrent laryngeal nerve can be immediately initiated should the patient’s voice becomes weak or hoarse
  • What pain medications are required after the procedure?
    Oral Tylenol and/or Ibuprofen are adequate before and after ablation. Taking a mild anti-anxiety, anti-spasm medication tablet such as Valium or Xanax prior to the procedure can improve the level of comfort during the procedure as well.
  • How successful is this procedure?
    Expertise in ultrasound guided therapies is a required to perform these challenging procedures. The effectiveness of therapy is measured by nodule volume reduction and preservation of normal thyroid function. The international data for nodule reduction has been overwhelmingly favorable for nodule reduction during the immediate months after therapy. We aim for a 60% reduction in volume in 3 months and a 90% volume reduction in one year. The success of the ablation is determined not only by the amount of energy delivered to each nodule but also the precision of the application. Symptom relief for the patient is associated with the volume reduction of the entire gland and is realized within weeks of the procedure.
  • What if the biopsy results are not benign?
    Treatment decisions after a thyroid biopsy may be complex. The evaluation of cells on slides (cytology) may not always determine if the tissue is benign. Surgical removal of the nodule for complete analysis is appropriate therapy for suspicious thyroid nodules to evaluate for the possibility of cancer. For patients interested in a nonsurgical approach, the indeterminate nodule can be further studied with genetic testing which provides further information about the anticipated behavior of the nodule. The appropriateness of RFA therapy versus thyroid removal can be considered. In the event that surgery may be required, a scar-less approach utilizing an endoscopic technique to remove the thyroid gland may be employed. Currently Dr. Richard Harding is the only surgeon in Arizona who is trained and experienced with this endoscopic trans-oral approach (TOETV).
  • What is the difference between RFA and RAI?
    Radiofrequency ablation (RFA) is a targeted therapy which uses high frequency alternating current to produce heat necessary to denature abnormal tissue precisely at the tip of the RFA probe. RAI involves Radioactive Iodine in the form of a tablet that is ingested by the patient. This is taken up by all thyroid tissue including the enlarged and hyperfunctioning nodule. The radioactive energy destroys the genetic elements in all thyroid cells, not just the abnormal thyroid tissue. Hypothyroidism is a common problem after RAI, but not RFA.
  • What is Dysphagia?
    Symptoms of difficulty and discomfort with swallowing are commonly referred to as dysphagia. When dysphagia is caused by an enlarged thyroid nodule, the symptoms are related to the mass effect of the thyroid itself. Symptoms of dysphagia often take several months to resolve after surgery. In our recent clinical experience, patients who undergo radiofrequency ablation of the thyroid have rapid decrease in the nodule volume. As volume reduces, symptoms from this enlargement resolve in a very short period as compared to surgery. At the Thyroid Nodule Treatment Center, we will be studying the effects of RFA on all patients regarding their swallowing symptoms.
  • What is Radiofrequency Ablation?
    Radiofrequency ablation (RFA) is a medical procedure where dysfunctional tissue is being ablated using heat generated from high frequency alternating current, passed from a generator to the tissue via an specialized electrode. Performed under local anesthesia, radiofrequency ablation is relatively painless and does not require general anesthesia. Doctors use ultrasound guidance to insert a probe into the thyroid nodule. Through selective heating of the probe tip, the intended nodule is denatured. The denatured tissue is then broken down by the body over the course of months. This process allows the nodule to dramatically reduce in volume without producing scarring or inflamation.
  • What is the issue with thyroid nodules?
    The thyroid gland is small, but it has a big job. While it is primarily responsible for controlling your metabolism, it ultimately affects nearly every part of your body. Although relatively common, nodules in the thyroid gland can affect how it performs and cause symptoms directly in the neck. Even though the vast majority of nodules are benign and not life-threatening, they can still cause problems. Some benign thyroid nodules may cause discomfort, problems with swallowing, produce excess thyroid hormone, or cause cosmetic concerns. Traditionally, thyroid surgery or radioactive iodine would have been the only treatment options for problematic thyroid nodules. While either method is generally safe, there are drawbacks to both.
  • What are the risks of Thyroid Surgery?
    Thyroid surgery, while a very safe procedure, is still surgery. It requires a trip to the hospital, general anesthesia, and the risks that come with both of those, to say nothing of the pain and recovery time. The risks specific to thyroid surgery include bleeding, scarring, hypothyroidism, damage to the vocal cord nerve, and calcium regulation issues. Damage to the nerve can affect the voice and cause permanent hoarseness. Cosmetically, one often ends up trading a lump for a visible scar. Hormonal changes after surgery could require a daily thyroid pill.
  • What are the risks of Radioactive Iodine Therapy?
    Radioactive iodine therapy has its challenges. This medicine is administered by specialist in Nuclear medicine and few endocrinologist. With this treatment there are short-term side effects such as nausea, swelling and tenderness in the neck area, dry mouth and a metallic taste. You may need multiple rounds of treatment, and this certainly will change any plans to become pregnant. A common long term complication is hypothyroidism
  • Where can I get RFA treatment?
    The use of radiofrequency in thyroid nodules has been utilized in Korea since 2002. The Korean and Italian protocols for benign thyroid disease have been studied internationally and are accepted for safe and effective therapies. The tremendous success of this treatment has created demand around the globe, only to be recently approved in the United States by the FDA in late 2018. Currently there are very few providers in the United States who perform this technique. Dr Harding is one of few providers in the southwest who is trained and equipped to offer this innovative office based therapy. Plan a trip to beautiful Arizona for your RFA treatment!
  • Is RFA the right treatment for me?
    If you have a large troubling thyroid mass but have been reluctant to undergo surgery, this treatment is ideal. You will not lose existing thyroid function or need thyroid medication after this procedure. There is lower risk and shorter recovery time compared with surgery. You can return to your usual routine within 24 hours after the procedure. Cosmetic neck deformities from large nodules improve in weeks. Symptoms of tightness and foreign body sensation dissipate quickly.
  • What Is the evaluation process?
    The proper evaluation of these nodules is very routine. Much of the thyroid assessment is based on the size of the nodule. Once nodules measure about 15 mm, size criteria are met for recommending an ultrasound guided biopsy. If there are some concerning features seen on ultrasound in a smaller nodule, a biopsy can be performed even if the size criteria are not met. Additionally, a nodule which is enlarging over a short time period should be sampled under ultrasound guidance. Very small nodules under 6 mm do not require a biopsy under most conditions. Many patients inquire if the presence of a nodule alters thyroid function. Generally, nodules do not alter normal thyroid function. Routine blood testing is performed to assess thyroid function. Hypothyroidism is not caused by thyroid nodules. If a patient has hypothyroidism, they should be thoroughly evaluated by their primary physician or an endocrinologist. Hyperthyroidism is rarely caused by toxic thyroid nodules. These nodules hyper-function and drive the hormone levels to an abnormal range. These over-functioning nodules cause symptoms of fatigue, insomnia, increased heart rate, and heat intolerance. If these symptoms exist, an endocrinologist is needed to regulate and suppress the thyroid function to normal levels. Further interventions can then be considered to restore normal thyroid function. Once a thyroid nodule is detected, your doctor will ask questions to determine if the nodule is causing symptoms. Examination of your neck is important to determine the relationship of the nodule to the surrounding structures like the trachea (windpipe) or esophagus (the swallowing tube from your throat to your stomach). You will also be assessed for enlarged lymph nodes in the neck, which may need to be evaluated further. Thyroid tests like a thyroid stimulating hormone (TSH) level will be checked to determine whether the nodule may be producing too much thyroid hormone. Nodules that make thyroid hormone are also known as “toxic”, “autonomous” or “hyperfunctioning” thyroid nodules and require additional evaluation as described below under toxic thyroid nodules. A sonogram of the thyroid is the best test to evaluate thyroid nodule structure. This gives information about the size and appearance of the nodule(s) and can help determine how likely a nodule is to be cancerous. Based on nodule size and appearance, along with other factors such as age and family history of thyroid cancer, a fine-needle aspiration biopsy (FNA) may be recommended. FNA is a safe office procedure that is typically very easily tolerated. FNA can help determine if the nodule is benign or worrisome for cancer.
  • What is a Thyroid FNA?
    A thyroid FNA (fine needle aspiration) is a biopsy of the thyroid that is harvesting cells using a very fine needle under ultrasound guidance. Multiple passes of the needle are necessary to accomplish this task. The cells are then inspected by a certified cytologist/pathologist. (Not all pathologists read cytology)
  • What conditions make me a poor candidate for RFA?
    Patients who are hypothyroid or have had prior thyroid surgery are not ideal patients for RFA. Certain exceptions do apply. Also those who have considerable extension of thyroid tissue deep to the clavicle are unable to receive complete treatment with RFA. Thyroid cancer is usually a contraindication unless the lesion is well below 1 cm in size and centrally located within the thyroid lobe.
  • Why are two biopsies required?
    Unless the nodule is an autonomous functioning nodule (rarely malignant), two individual biopsies are required to conclude that a lesion is not cancer. With Thyroid RFA, the nodule is not reviewed by a pathologist for analysis. After RFA therapy, surveillance ultrasound might identify irregularities within the nodule which could be interpreted as suspicious. This interpretation may prompt further biopsies. Tissue cytology may look more atypical after RFA treatment . For that reason the assurance of benign thyroid tissue is critical prior to any RFA intervention. Biopsies are referred to as Fine Needle Aspirations.
  • What are the main differences between thyroid surgery and RFA?
    Radiofrequency ablation (RFA) is a nonsurgical treatment option for thyroid nodules. RFA applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. The benefits are the elimination of the symptoms from the large nodule and preservation of thyroid function.
  • What is RFA?
    Radiofrequency ablation for the treatment of thyroid nodules is a procedure performed by Dr. Richard Harding. RFA uses high frequency alternating current to create heat that is applied to very small areas to destroy thyroid tissue. The term radiofrequency (RF) refers to an alternating electric current oscillating between 200 kHz and 1200 kHz. Application of Radiofrequency agitates tissue ions as they attempt to follow the changes in the direction of the alternating current, thus creating frictional heat around the electrode. Although heat creates immediate damage to the tissue, this is significant only in regions within a few millimeters of the electrode. The net effect of this treatment is reduction in the size of thyroid nodules. This minimally invasive technique is performed through pinhole size incisions. It is a less invasive alternative to surgery and does not involve radioactive elements to destroy the thyroid tissue. RFA is a safe way to treat patients with symptomatic thyroid nodules.
  • Who are the appropriate patients for Thyroid RFA (Radio Frequency Ablation)?
    Patients who have large nodules (over 2 cm) which have been identified by CT scan or ultrasound and who have discomfort or symptoms of compression. One or two ultrasound guided FNA biopsies of the individual nodules are necessary to prove that this tissue is benign. Patients who have thyroid nodule symptoms will receive a comprehensive evaluation including neck ultrasound, ultrasound guided biopsies, and thyroid nodule radiofrequency ablation in one location. In order to be a candidate for the radiofrequency ablation, a patient needs two sequential biopsies to prove that they do not have a thyroid cancer. Those who are not candidates for this procedure will have the opportunity to discuss other surgical options available to them.
  • What are the current contraindications to RFA therapy?
    Pregnancy, active coronary disease, prior neck irradiation, prior thyroid or lymph node malignancy, and anti-coagulation therapy. Thyroid nodules extending deep to the clavicle are only partially treated with this approach.
  • Which nodules get treated by RFA?
    Thyroid Nodules that are treated with RFA; Symptomatic thyroid nodules proven to be benign with several biopsies which are over 2 cm and not below the clavicle. All nodules studied with ultrasound should have a benign appearance. All prominent nodules present should be individually biopsied regardless of side of the thyroid. Nodules should not be larger than 100 ml for a single treatment.
  • Will my insurance cover RFA?
    Currently the evaluation of the thyroid nodules is covered by insurance companies. However, radiofrequency ablation of thyroid nodules is new and is not considered a recognized benefit. As the exciting success of thyroid RFA is recognized, the insurance companies are paying and reimbursing more frequently. This therapy will save the patient and the entire healthcare system a considerable amount of money. As the healthcare community and patients continue to advocate for this non-surgical solution of benign thyroid nodules, the availability to utilize insurance healthcare benefits will increase. You can demand an appeal to an insurance coverage denial, using the following suggestions and TNTC materials. Suggestions to appeal insurance denial 2. How to Appeal Denied Claims from the National Association of Insurance Commissioners 3. Insurance Authorization Letter for Radiofrequency Ablation of the Thyroid Gland from the Thyroid Nodule Treatment Center. Additional Information
  • Why is my benign thyroid nodule problematic?
    Larger nodules become more symptomatic as they push against the esophagus and trachea. This may cause difficulty with breathing and swallowing. They may also cause unwanted deformity or distortion of the normal neck contour. Additionally, some nodules produce excessive thyroid hormone causing many other symptoms and health problems.
  • What if I have hyperthyroidism?
    Some patients have hyperthyroidism related to a nodule with autonomous function (AFTN). Autonomously functioning thyroid nodules can create symptoms of fatigue and rapid heart rate. The determination of AFTN is optimally made with an I123 Iodine Uptake Scan to show increased iodine uptake in the nodule compared to the remainder of the gland. This precisely directed therapy can destroy these nodules with RFA, avoiding both surgery and hypothyroidism related to radioactive iodine. Restoration of normal thyroid function is accomplished in most patients. No daily thyroid medications are required after Thyroid RFA of AFTNs! Hyperthyroidism caused by Grave’s disease is not managed with RFA therapy.

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Phoenix, AZ 85004

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