The authors of a recent study, “Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules—Expanding Treatment Options in the United States,” published in the Journal of the Endocrine Society, found that RFA is safe and effective for treating benign thyroid nodules that cause problems due to their size or function. RFA is less risky than surgery and radioactive iodine, and it helps keep your thyroid working properly. In this study, doctors looked at how well radiofrequency ablation (RFA) worked for people with thyroid nodules. The study was done by reviewing the charts of patients who had RFA for their thyroid nodules at The Thyroid Clinic in Salt Lake City, Utah between November 2018 and January 2021. All patients had a physical exam, blood tests for thyroid function, and thyroid ultrasound before the procedure. Patients who had suspicious findings on the ultrasound had a thyroid biopsy. Patients who had metal hardware/ pacemaker, pregnancy, or suspicious results on fine-needle aspiration biopsy were not treated with RFA procedure. The nodules that were producing too much thyroid hormone causing hyperthyroidism and nodules that were mostly solid and were bothersome due to their size causing pressure in the neck and choking symptoms or cosmetic concerns were treated with RFA. The doctors found that RFA was successful in shrinking the nodules in most patients. In fact, the average decrease in size was 70% on initial evaluation. The volume of the smaller nodules decreased more than the larger nodules. Thyroid blood tests and hyperthyroid symptoms improved in the nodules making too much thyroid hormone. Thyroid function tests remained normal in the nodules that were treated due to size. There were no major complications. Thyroid nodules are small lumps that can grow in the thyroid gland, which is located in the neck. They are common and can be found in more than half of the population in the United States. Most of the time, they do not cause any problems. However, some nodules can be cancerous and require surgery. If the nodule is not cancerous, it can still cause problems if it grows too large and causes discomfort or changes the appearance of the neck. Another situation that can be harmful is when the nodule produces too much thyroid hormone, which can cause hyperthyroidism. In these cases, doctors may recommend surgery or radioactive iodine therapy to remove or shrink the nodule. Both treatments have some risks, such as hypothyroidism, which means that you may need to take thyroid hormone replacement pills for the rest of your life. Surgery can also leave a scar and sometimes affect your voice. In recent years, doctors have been using new treatments to help people with thyroid nodules. One of these treatments is called radiofrequency ablation (RFA). During RFA, a thin needle is inserted into the nodule under ultrasound guidance. Then, an electrical current passes through the needle, which generates heat and burns the cells inside the nodule. This causes the nodule to shrink and turn into scar tissue. The best part is that this procedure can be done in the doctor’s office without putting you to sleep with general anesthesia. However, only a few doctors in the United States are experts in administering this treatment. Dr. Richard Harding has performed over 90 RFA treatments in the last 3 years. Cited Research Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. “Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules—Expanding Treatment Options in the United States.” Journal of the Endocrine Society, vol. 5, no. 8, Aug. 2021, p. bvab110. DOI.org (Crossref), https://doi.org/10.1210/jendso/bvab110.

The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Dr. Richard Harding has been an American College of Surgeons Fellow since 1998. The American College of Surgeons (ACS) is a scientific and educational association of surgeons that was founded in 1913 to improve the quality of care for the surgical patient by setting high standards for surgical education and practice. The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the ACS are referred to as "Fellows." The letters FACS (Fellow, American College of Surgeons) after a surgeon's name mean that the surgeon's education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College. Attending the American College of Surgeons Clinical Congress events in Boston, Dr. Harding is delighted to reconnect with residents that he has trained over the years as well as many colleagues from the professional organizations he is a member of. Dr. Harding has taught residents in his role as Associate Professor in Surgery, Creighton University School of Medicine, Assistant Professor of Surgery, University of Arizona College of Medicine, and trainings he has provided on Thyroid Radiofrequency Ablation (RFA). In addition to being a Fellow of the American College of Surgeons , Dr. Harding is also a member of other surgery organizations including North American Society for Interventional Thyroidology American Association of Endocrine Surgeons Arizona Chapter American College of Surgeons Phoenix Surgical Society Maricopa County Medical Society Arizona Medical Association Dr. Harding has dedicated a large part of his practice to endocrine surgery. He has performed over 2000 endocrine operations for adrenal, thyroid and parathyroid conditions. He is active in the American Association of Endocrine Surgeons. He is the first surgeon in the Southwest to perform a Transoral Endoscopic Thyroidectomy, which has the benefit of leaving no visible surgical scar. He is very familiar with the latest treatment guidelines for both thyroid and parathyroid diseases. He now also performs a Laparoscopic posterior adrenalectomy which significantly decreases recovery time for adrenal surgery conditions. For patients' convenience, many diagnostic tests and minor procedures can be performed in his office, including diagnostic ultrasound, ultrasound lymph node mapping, and ultrasound guided thyroid nodule biopsies. Dr. Harding also treats simple and complex hernias, gallbladder disease, colon cancer, diverticulitis, and gastroesophageal reflux conditions. He performs many abdominal wall reconstructions in patients who have complex hernia conditions, usually resulting from prior surgical procedures or prior failed ventral hernia repairs. Richard J. Harding, MD has been evaluating and removing hundreds of thyroid glands per year for the past twenty-eight years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method applies internal energy to the thyroid nodules to effectively destroy problematic tissue without injuring the healthy outer thyroid gland. Let the most experienced thyroid surgeon in Arizona Save Your Thyroid!

The management of nodular thyroid disease has changed dramatically within the past decade. 1 Improvements in imaging technology as well as sophisticated cytologic testing can now differentiate low risk lesions from high-risk lesions without thyroid removal for pathologic confirmation. The confidence in this testing now allows us to treat and destroy symptomatic benign thyroid disease using highly technologic minimally invasive treatments . 2 Thyroid nodular disease is common and is present in all ages. Over half of the population over 50 years old will have at least one thyroid nodule. Most of these nodules will be asymptomatic and are discovered with imaging tests ordered for unrelated issues. The patients with larger nodules, however, are identified early due to visible and palpable neck deformity. Symptoms for patients with large thyroid nodules often include choking, swallowing difficulty, foreign body sensation, and hoarseness. Many patients simply notice a large lump in their neck either unilaterally or central. The evaluation of these patients begins with a designated neck ultrasound to include the thyroid gland and inspection of the central and lateral lymph node zones. The Thyroid Imaging Reporting and Data (TI-RAD) score in neck ultrasound helps to distinguish indeterminant thyroid lesions which could be at risk for malignancy. This score helps to guide which lesions should be considered for ultrasound guided fine needle aspiration biopsy. 3 Once the nodules’ cytology is confirmed, specific treatment options can be discussed. Indeterminant nodules and malignant disease is managed with surgical resection according to the American Thyroid Association Guidelines. Patient undergoing surgery by high volume thyroid surgeons have been demonstrated to have the lowest morbidity and shortest hospital stays . 4 , 5 Symptomatic benign thyroid nodules can now be managed with percutaneous thermal ablation techniques. The three technologies effective for this include laser fiber ablation, radiofrequency ablation (RFA), and high frequency ultrasound ablation. Currently only laser fiber ablation and radiofrequency ablation (RFA) are available in the United States. With radiofrequency, the tissue immediately adjacent to the probe vibrates at such high frequency that heat is created, thus altering the cellular membrane proteins. The warmed tissue is unable to recover and is devitalized. Cooled RFA probes advanced under ultrasound guidance are used to safely destroy the entire thyroid nodule without injuring adjacent tissue. With laser ablation, a laser fiber is introduced into the middle of a nodule and the energy is applied for circumferential heating of the tissue, intentionally leaving a rim of untreated tissue. The adjacent normal tissue is preserved, and thyroid function is unaltered. This has the benefit of avoiding the potential complications of surgery, avoiding hypothyroidism, avoiding the surgical recovery, and avoiding a surgical incision. For many patients this non-surgical option is a highly desirable. The management of toxic or autonomous nodules (AN) is rapidly being transformed by this new technique. Destruction of a well-defined AN rapidly creates a euthyroid patient within days. The nodule also shrinks in size within weeks of treatment. No longer is it necessary to stay on marginally effective antithyroid medications experiencing frequent breakthrough hyperthyroid symptoms. Symptoms of palpitations, heat intolerance, and anxiety quickly resolve. Additionally, treatment with radioactive iodine can also be avoided given its associated risk of hypothyroidism, bone marrow suppression, and long-term potential for hyperparathyroidism. The short-term management of these treated RFA patients involve scheduled surveillance ultrasound examinations of the treated area to document tissue destruction and volume reduction. In these visits normal thyroid function is confirmed and structural changes in the thyroid gland are documented. These scheduled visits are at 1, 3, 6 and 12 months after treatment. Huge thyroid nodules are also effectively treated with this regimen. Nodule volume reduction leads to symptom resolution. Large nodules well above 50 ml in size will shrink by over 50% in three months and generally over 80% in 6 months. These patients notice dramatic improvement in their ability to breath, swallow, and sleep in ways they never imagined. This is all achievable with a procedure performed under a local anesthetic block. Conditions which disqualify patients include cancer, pregnancy, pacemaker, indeterminant lesions, and inability to undergo a local anesthetic block. Prior thyroid surgery with nerve injury is also a relative contraindication. Statistics on outcomes for these procedures have documented complication rates which are one tenth of surgery complication rate. Thermal Ablation of thyroid nodules is a paradigm shift in the management of structural thyroid conditions, not associated with neoplastic disease. The cost savings to the healthcare system will be realized by 1. avoiding hospital expenses, 2. avoiding lifelong medications for hypothyroidism, and 3. avoiding costs for complications incurred with surgery. With a capable provider, nodule ablation is now performed as an office-based procedure with amazing efficacy. Patient demand and satisfaction has been extremely high. Bibliography 1 . Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. https://doi.org/10.1089/thy.2015.0020 . PMID: 26462967; PMCID: PMC4739132 2 . Nishino, M., & Nikiforova, M. (2018). Update on Molecular Testing for Cytologically Indeterminate Thyroid Nodules . Archives of pathology & laboratory medicine, 142(4), 446–457. https://doi.org/10.5858/arpa.2017-0174-RA 3 . Patel, K. N., Yip, L., Lubitz, C. C., Grubbs, E. G., Miller, B. S., Shen, W., Angelos, P., Chen, H., Doherty, G. M., Fahey, T. J., 3rd, Kebebew, E., Livolsi, V. A., Perrier, N. D., Sipos, J. A., Sosa, J. A., Steward, D., Tufano, R. P., McHenry, C. R., & Carty, S. E. (2020). The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults . Annals of surgery , 271 (3), e21–e93. https://doi.org/10.1097/SLA.0000000000003580 4 . Zhang J, Liu BJ, Xu HX, Xu JM, Zhang YF, Liu C, Wu J, Sun LP, Guo LH, Liu LN, Xu XH, Qu S. Prospective validation of an ultrasound-based thyroid imaging reporting and data system (TI-RADS) on 3980 thyroid nodules. Int J Clin Exp Med. 2015 Apr 15;8(4):5911-7. PMID: 26131184; PMCID: PMC4484032. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484032/ 5 . Adam, M. A., Thomas, S., Youngwirth, L., Hyslop, T., Reed, S. D., Scheri, R. P., Roman, S. A., & Sosa, J. A. (2017). Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes? . Annals of surgery , 265 (2), 402–407. https://doi.org/10.1097/SLA.0000000000001688

The American Thyroid Association Statement on Ablation Techniques for Benign Thyroid Nodules recently published a thorough article that outlines implementation, qualification, methodology, and protocols for optimizing safety for the introduction of thermal ablation in clinical practice. This is an essential reference for all physicians hoping to embark upon interventional thyroid procedures. The endorsement of the American Association of Endocrine Surgery, American Academy of Otolaryngology, Head and Neck Surgery, American Head and Neck Society, Society of Interventional Radiology, Latin-American Thyroid Society, Asia and Oceania Thyroid Association, and Asia Pacific Society of Thyroid Surgery indicate the intense scrutiny assigned to this important reference and the broad scope of subspecialties it affects. The collective effort addresses nuances, highlighting the complexity of care associated with thyroid nodule management. The article clearly demonstrates the considerations and complexities of patient evaluation, pre-procedural planning, patient treatment, and post-procedural management. This enthusiastic effort is presented in the interest for our patients whom have experienced overwhelmingly positive results with this treatment modality. The full article is available for download.

Dr. Richard Harding is an expert in thyroid care, with 28 years of experience in evaluating and removing hundreds of thyroid glands per year. He is proud to offer RFA as a safe and effective option for his patients with benign thyroid nodules. RFA, or Radiofrequency ablation, is a non-surgical treatment that can transform the lives of people with large benign thyroid nodules. It uses internal energy to target and destroy the unwanted tissue, while preserving the healthy outer thyroid gland and its function. Success Stories RFA has many advantages over conventional surgery or RAI, such as lower risk of primary hypothyroidism (low thyroid hormone), faster recovery, and no scarring. Testimonials Our patients are very happy with the results of the RFA procedure, which allows them to avoid thyroid surgery and its complications. They can go home right after the treatment and resume their normal activities. Read More ​Success Stories ​Testimonials ​About Dr. Richard Harding ​Frequently Asked Questions

The treatment of these thyroid nodules varies on the nature of the nodules as well as the symptoms produced. Any malignancy will need to be removed if it is over 15 mm. Some smaller malignancies are now being followed without surgery. These are followed utilizing strict criteria and under research-based protocols. The success of this non-operative surveillance of small cancers has been very successful. Small nodules tend not to create symptoms, whereas large nodules can create many problems such as difficulty with breathing when laying flat, difficulty with swallowing solid food (pills), and even a chronic cough. Nodules with compression symptoms can be removed with surgery. If they are not cancer and not suspicious for the possibility of cancer, than a minimally invasive, ultrasound guided therapy can effectively destroy the nodule. This treatment applies energy directly to heat it up to the point of tissue death. Once the tissue is devitalized, the body walls off and slowly reabsorbs the treated tissue. This method leaves the adjacent normal tissue unharmed and thus preserves the thyroid function. Unfortunately, with surgery the entire side (lobe) is generally removed due to safety concerns. This unavoidably removes the abnormal and normal tissue on the entire side. Approximately 60-75% of these patients will require thyroid hormone supplementation. If a biopsy raises a concern for the possibility of cancer, then surgery is recommended to allow for proper analysis of the tissue by pathologist. The surgery should be performed by a surgeon very familiar with thyroid operations, and who performs them regularly. The definition of a high- volume thyroid surgeon is currently established at 25 operations annually. The Thyroid Nodule Treatment Center is available to navigate the numerous diagnostic and therapeutic options with you. Patients with normal thyroid function and who are symptomatic from large thyroid nodules can present immediately to review treatment options. This includes large visible nodules which are cosmetically distracting. The most innovative therapy may be available to you. International studies demonstrate excellent immediate and long- term results with radiofrequency ablation. A list of expert endocrinologists will be provided for those patients who have a complex endocrine history and require further evaluation, and long term care.

Dr. Richard J Harding has been evaluating and removing hundreds of thyroid glands per year for the past twenty years. He is very pleased to introduce a non-surgical treatment for large benign thyroid nodules. This new method 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. Many people have inquired about simply removing only the symptomatic nodule during surgery and leaving the residual healthy thyroid tissue. From the surgical perspective, this would cause complications including bleeding during and after surgery. Additionally, the way the body would respond to this type of procedure could create more problems than it solves. For this reason the removal of the entire thyroid lobe is generally advised. With this new Radiofrequency technique, the energy can be applied under precise ultrasound guidance and the damage to the healthy tissue is minimized. The functioning thyroid lobe is preserved, the thyroid nodule shrinks in size, and the main objectives are accomplished. Radiofrequency energy is currently being utilized for many tissue types in the body including veins, nerves, liver, and kidneys. The use of radiofrequency in thyroid nodules has been utilized in Korea since 2002. The Korean and Italian protocols for use with benign thyroid disease has been studied internationally such that entire protocols are accepted for safe and effective therapies. For this very reason this technique has spread 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. Many people have been traveling to Italy and Korea to have their nodules treated. This is no longer necessary as the procedure can be performed in my surgical office. 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 of course will have the opportunity to discuss other surgical options available to them. Currently the evaluation of the thyroid nodules is covered by insurance companies, however the radiofrequency ablation of thyroid nodules is not considered a recognized benefit. We are hopeful this will change as more surgeons and endocrinologists establish more experience with this technique and both the healthcare community and patients advocate for the non-surgical solution to the treatment of benign thyroid nodules.

What is the difference between a patient's experience with thyroid surgery vs. thyroid Radiofrequency ablation (RFA)? Dr. Richard Harding explains the process in this video: Radiofrequency ablation (RFA) is a minimally invasive technique that uses heat to destroy benign thyroid nodules. It has been widely used in Asia and Europe for over a decade, and it is now gaining popularity in the United States. RFA has several advantages over surgery, such as preserving the normal thyroid function, avoiding surgical scars and complications, reducing the cost and recovery time, and improving the cosmetic outcome. RFA uses a thin needle electrode that is inserted into the nodule under ultrasound guidance. A high-frequency electric current is then passed through the electrode, creating heat that destroys the nodule tissue. The procedure is performed under local anesthesia and takes about 15 to 30 minutes per nodule. The patient can go home the same day and resume normal activities within a few days. The nodule size and symptoms usually decrease significantly within a few months after RFA. RFA is suitable for patients who have benign thyroid nodules that cause pressure symptoms, such as difficulty swallowing, breathing, or speaking, or that are cosmetically bothersome. RFA can also be used for patients who have recurrent nodules after surgery or who are not good candidates for surgery due to medical conditions or personal preference. RFA is not recommended for patients who have malignant or suspicious nodules, as they may require complete removal of the thyroid gland and lymph nodes. RFA is a safe and effective alternative to surgery for benign thyroid nodules. It has been shown to reduce the nodule volume by 50% to 90%, improve the quality of life and satisfaction of patients, and have a low complication rate of less than 1%. If you are interested in learning more about RFA or scheduling a consultation, please contact us today.

Save Your Thyroid! The benefits of Radiofrequency Ablation Treatment (RFA) are the elimination of the symptoms by shrinking the large nodule while preserving thyroid function. Eliminate Compression Symptoms Shrink Thyroid Nodules No Incision or Scarring Preserve Thyroid Function Nonsurgical Alternative to Thyroidectomy Eliminate Toxic Thyroid Nodules Over the years many people have inquired about simply removing just the symptomatic nodules and leaving the residual healthy thyroid tissue during a thyroid operation. Although the concept is relevant, the attempt to perform this type of operation would lead to complications such as bleeding during and after surgery. The healing process to this complex procedure would create more problems than it solves. For this reason the removal of the entire thyroid lobe is always advised. However, with this new minimally invasive Radiofrequency technique, the energy can be applied under precise ultrasound guidance. The injury to the healthy tissue is minimized. Post procedure scarring, discomfort, and bleeding is minimal. The normal functioning thyroid lobe is preserved while the thyroid nodule shrinks in size over a short period of time. The objectives are accomplished through a pinhole incision under local anesthesia Advantages of RFA treatment RFA is relatively painless RFA does not require general anesthesia. RFA is a non-surgical alternative to thyroidectomy and radio-iodine ablation The procedure itself takes less than an hour, the entire process may take 2-3 hours. Compared with surgery, the primary advantages of radiofrequency ablation are: Increased likelihood of preservation of thyroid function. The potential of fewer complications. Generally shorter recovery time with a quick return to normal activities Radiofrequency ablation may also minimize the risk of permanent damage to the vocal cord nerve or to the parathyroid glands 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. The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain. Other than the initial injection of numbing medication, the only remaining sensation is generally pressure Intermittent sensations of discomfort thereafter can be treated with additional doses of pain medication or adjustment of the probe tip. Often, difficulty swallowing, feelings of pressure or tightness of the throat, or even the bulky appearance of the nodule is usually significantly decreased or no longer detectable.

The research is a systematic review and meta-analysis of studies that evaluated the long-term results of thermal ablation of benign thyroid nodules. Thermal ablation is a minimally invasive technique that uses heat to destroy abnormal thyroid tissue. The research compared two types of thermal ablation: radiofrequency ablation (RFA) and laser ablation (LA). The research included 14 studies with a total of 1,434 patients who underwent thermal ablation and had follow-up data of more than 3 years. The research found that thermal ablation was safe and effective for reducing the volume of benign thyroid nodules, with no unexpected delayed complications. The research also found that RFA was superior to laser ablation (LA) in terms of volume reduction rate, regrowth rate, and delayed surgery rate. The research concluded that thermal ablation (RFA) is a viable option for treating benign thyroid nodules. Read the full research. Visit Resources for more research downloads.

RFA is relatively painless RFA does not require general anesthesia. RFA is a non-surgical alternative to thyroidectomy and radio-iodine ablation. Increased likelihood of preservation of thyroid function. Fewer complications than surgery Much shorter recovery time with rapid return to normal activities. No surgical incision. Radiofrequency ablation minimizes the risk of permanent damage to the vocal cord nerve or to the parathyroid glands. Radiofrequency ablation does not cause any scarring to the external neck. In most cases, one puncture of the skin is sufficient to treat the entire thyroid gland Because it is minimally invasive and does not require general anesthesia, you avoid the internal and external scarring of traditional thyroid surgery, and the associated risks of anesthesia. Pre-procedural symptoms with difficulty swallowing, feelings of pressure or tightness of the throat, or even the bulky appearance of the nodule are significantly decreased or no longer detectable. The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain. Other than the initial injection of numbing medication, the only remaining sensation is generally pressure and of increased heat in the neck area. Intermittent episodes of discomfort can be treated with additional doses of pain medication or adjustment of the probe tip. The procedure itself takes less than an hour, the entire process may take 2-3 hours. You should be able to return to most of your regular daily activities almost immediately. Radiofrequency thyroid ablation will not affect your energy or strength.

Symptoms of difficulty and discomfort with swallowing are commonly referred to as dysphagia. Swallowing is a very dynamic process which requires coordinated movement of the larynx, esophagus, and trachea. The thyroid is attached anteriorly to the trachea and larynx and can interfere with normal swallowing process when enlarged. Surgery to remove an enlarged thyroid gland can resolve symptoms of dysphagia. Surgery can also cause symptoms of dysphagia which did not exist before the operation. Post operative dysphagia is felt to be related to scarring, fibrosis, and nerve disruption associated with the removal of a thyroid gland. Often these symptoms may take months to resolve. With dysphagia associated with 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. This needs to be quantified in a scientific fashion. At the Thyroid Nodule Treatment Center, we will be studying the effects of RFA on all patients regarding their swallowing symptoms. We will have all patients complete surveys of their symptoms before and after their procedure, and in subsequent visits. This will help validate and measure the long lasting effects of RFA with symptoms that alter quality of life. Thank you in advance for your participation in this valuable study.