Information about Thyroid Radiofrequency Ablation for Patients
This is a minimally invasive thyroid procedure that is performed in the office with a special needle and dramatically shrinks benign thyroid nodules. It is a very good alternative to surgery and does not leave a scar. With Thyroid RFA, you can get an effective treatment with very fast recovery, without needing to take time off work (other than for the day of the procedure), and without having to worry about potential surgical complications.
Please read the FAQ section below, for more information about Thyroid RFA!
Patient fully recovered within 2 hours after treatment, and happy to have avoided surgery
Frequently Asked Questions (FAQ)
What is Thyroid RFA?
This is cutting edge technology used for the treatment of benign thyroid nodules. We utilize alternating electric current to agitate tissue ions, resulting in ionic friction, which in turn causes heat production. The heat is transferred from the needle (electrode) tip to the surrounding thyroid tissue, at a pre-specified area that is dependent on the type of electrode used (7 mm or 10 mm diameter of treated area), allowing the operator precision and accuracy. So, basically, we use electricity to generate heat in a small area inside the thyroid nodule. The doctor inserts the needle under ultrasound guidance using the trans-isthmic approach (from the middle of the neck), and when it is at the target area of the nodule, the RF generator is activated and the procedure starts. The doctor subsequently uses the “moving shot” technique, to move the needle throughout the whole nodule, so that 100% of the nodule is ablated. At the end of the procedure, all or most of the nodule’s cells are dead, without compromising the cells of the healthy thyroid, and the nodule dramatically shrinks over the following months.
The trans-isthmic approach and moving shot technique were developed to ensure safety, accuracy, and effectiveness of the procedure. They are now the standard of care for Thyroid RFA procedures in the world, and are the techniques used at the Thyroid Institute of Utah.
How effective is Thyroid RFA for large benign solid thyroid nodules?
Thyroid RFA is considered successful when the nodule shrinks by >50%. On average, thyroid RFA shrinks solid thyroid nodules by 80%, with a range of 65-94%, so the results are usually really good! Sometimes, the nodules disappear completely. Almost all patients have great symptomatic improvement, with complete or almost complete resolution of their compressive symptoms and/or cosmetic concerns. Significantly more than half the patients (around 90%) will do well with a single RFA session. A minority of patients with very large nodules may require more than one RFA session, to achieve the best outcomes and prevent future re-growth.
For hyperfunctioning thyroid nodules, the volume reduction is similar, and hyperthyroidism eventually resolves in 50-80% of the patients.
It is important to note that thyroid RFA does not lead to these results immediately. There is significant tumor reduction within a month after the treatment, but the nodules continue to gradually shrink for up to a year after the RFA procedure.
What are the benefits of Thyroid RFA compared to surgery?
• Much less invasive procedure, with no scar.
• No risk from anesthesia, as we use topical anesthetic only.
• No need for a hospital stay.
• Almost no time needed for recovery. Patients can return to their normal activities the next day!
• You only need to take time off work for the day of the procedure.
• Much lower complication rates.
• Almost no risk for hypothyroidism after the procedure.
• Lower cost.
What are the indications for Thyroid RFA?
Thyroid RFA is indicated for benign thyroid nodules that:
• are causing compressive symptoms (difficulty swallowing, voice change, difficulty breathing, foreign body sensation in the neck, etc.).
• are toxic (overfunctioning), causing hyperthyroidism.
• cause cosmetic concerns due to their size.
• form large multinodular goiters.
• a doctor has recommended surgery for their treatment, and the patient is not a surgical candidate, or would prefer to avoid surgery.
When is surgery preferred over Thyroid RFA?
Sometimes RFA is not possible, or it is not recommended. The following are some scenarios that surgery is preferred over Thyroid RFA:
• there is known thyroid cancer, or there is high suspicion for thyroid cancer.
• the thyroid nodule extends to areas that cannot be accessed for treatment with RFA, such as behind the trachea or inside the chest.
• there is a large substernal goiter (large amount of thyroid tissue getting in the chest).
• there are heavy calcifications in the nodule, which are expected to prevent us from advancing the needle.
• there is concomitant Graves’ disease and surgery has been recommended as the best treatment of this disease for the patient.
What are the complications of Thyroid RFA?
Thyroid RFA is a very safe procedure, with a very low complication rate, much lower compared to surgery. With the use of special techniques, such as the trans-isthmic approach and moving shot technique, the complication rate of Thyroid RFA decreases even further!
Pain during the procedure is not uncommon, but decreases with the carefully applied lidocaine around the thyroid capsule. It tends to happen only during the procedure when there is energy delivery, with subsequent complete resolution of the pain. Other minor side effects of the procedure are very uncommon, and include nausea, vomiting, mild skin burn, parasympathetic reaction (such as temporary slow heart rate or feeling of faint), fever.
The following are the potential serious complications of thyroid RFA and their frequency, based on the most recent literature review of thousands of patients:
• Temporary voice change: 0.94%
• Permanent voice change: less than 0.17%
• Nodule rupture: 0.17% (usually treated conservatively, surgery is rarely indicated)
• Hematoma: rare, usually disappears within 1-2 weeks
• Hypothyroidism: exceedingly rare
• Other nerve damage: exceedingly rare
• Infection/abscess formation: exceedingly rare
• Life-threatening complications: none reported so far
Am I a candidate for Thyroid RFA?
In order to be a candidate for Thyroid RFA, the patient must:
• not have thyroid cancer or suspicion of thyroid cancer.
• have had 2 FNA biopsies of the target thyroid nodule that are benign on cytopathology, for inactive (cold) thyroid nodules.
• have had 1 FNA biopsy of the target thyroid nodule that is benign on cytopathology, for overactive (toxic/hot) thyroid nodules.
• be able to get off anticoagulation for the time of the procedure (for patients on blood thinners)
What is the cost for Thyroid RFA?
The cost of Thyroid RFA can be variable depending on where it is performed. If performed in a hospital or surgical center, the cost can be very high, between $7,000 - $25,000. Using conscious sedation can increase that cost further as payment is needed for the anesthesiologist and the intravenous medications.
Our focus is making Thyroid RFA safe, effective, accessible, and affordable. We do this by eliminating or minimizing the costs associated with a hospital, surgical center, and anesthesia. At the Thyroid Institute of Utah, the RFA procedure is performed in the office with local anesthesia only and with no increase in the risk of the procedure. The cost of Thyroid RFA at the Thyroid Institute without insurance coverage is $3,000. However, we will work with your insurance company to determine coverage, benefits, and out-of-pocket cost. Make sure to ask us for a 2nd opinion before committing to surgery or RFA with another physician.
So, if you have been told you need surgery for a benign thyroid nodule, and you are interested in non-surgical alternatives, contact us to learn more about Thyroid RFA, and know about all your treatment options, so that you can choose the best treatment that fits your needs!
Dr Segkos performing the RFA procedure with ultrasound guidance