Radiofrequency ablation (or “RFA”) is a non-surgical treatment for thyroid nodules. It uses an electrode that resembles a needle to direct focused heat energy which ablates (or destroys) the thyroid nodule. This leads to a long-term significant decrease in the size of the nodule, usually in the range of 50-90% of the original nodule volume. These therapies are best used to alleviate symptoms associated with large thyroid nodules and can be an effective non-surgical alternative to help patients avoid thyroid surgery, permanent scarring, and the need for lifelong thyroid medications.

The Basic RFA Technique

While treatment methods can vary, the procedure is typically performed with the patient lying on their back, with the neck slightly extended (chin up to the sky). The neck area is cleaned and numbed, and sterile drapes or towels are placed to keep the area clean. An RFA needle is inserted through the skin and is guided into the thyroid nodule using ultrasound imaging. An electric current is used to generate a precisely focused amount of heat at the tip of the needle which is moved throughout the nodule. Once all the key areas of a nodule have been ablated, patients can go home shortly after the procedure and the nodule (or nodules) will slowly shrink over time.

Thyroid nodules are common, and by age 60 almost ½ of normal healthy people have nodules that can either be felt in the neck or found with an imaging test like an ultrasound. The majority (>90%) of all thyroid nodules are non-cancerous. They are more common in women than men and more common as you age. Most nodules cannot be felt by you or your physician and usually go unnoticed until they are found by accident on an imaging test done for another reason, such as a CT scan or MRI of the neck or chest. Others can be easily felt and are sometimes large enough to cause symptoms, including choking, trouble swallowing, or rarely, hoarseness of the voice. However, the majority of nodules do not cause these symptoms.

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Some thyroid nodules release too much thyroid hormone, causing hyperthyroidism (overactive thyroid). Unlike normal nodules, these nodules lose the ability to modulate the release of thyroid hormone in response to increasing levels in the bloodstream and are therefore called “toxic”, “autonomous” or “hyperfunctioning” thyroid nodules.

Toxic nodules may be found during the evaluation of symptoms of hyperthyroidism, such as palpitations, tremor of the hands, intolerance of heat, or unintentional weight loss. Some patients do not have these symptoms and hyperthyroidism on routine lab testing can also lead to the discovery of a toxic nodule.

Suspicious thyroid nodules are usually identified by ultrasound imaging features that are associated with an increased risk of thyroid cancer.

These features include

• an appearance darker than the surrounding thyroid (hypoechogenicity),