Thyroid Disease Treatment, RFA

The treatment of thyroid disease depends on many factors, including the type and severity of the disorder, and the patient’s treatment goals. Our endocrinologists tailor treatment to the unique needs of each patient, using a collaborative multidisciplinary team approach. Physicians who specialize in endocrinology, endocrine surgery, pathology, radiology, nuclear medicine and other areas may be involved in treatment.

Thyroid nodules, whether cancerous or benign, may require surgical treatment. Thyroid nodules causing discomfort, difficulty swallowing, cough or foreign body sensation can either be watched over time or treated with thyroid surgery to remove the half of the thyroid causing these symptoms. Thyroid nodules can sometimes cause hyperthyroidism, or an excess of thyroid hormone. Treatment for this includes medication to block the production of thyroid hormone followed by thyroid surgery.

Radiofrequency ablation of the thyroid offers another option to address thyroid nodules that cause compressive symptoms or an increase in thyroid hormone levels.

Radiofrequency Ablation (RFA) to Treat Thyroid Nodules

Thyroid RFA is an outpatient procedure that allows for the destruction of thyroid nodules with the use of a needle-like probe. It provides patients with a nonsurgical treatment option that preserves unaffected normal thyroid tissue. Clinical studies in Europe, Asia and the U.S. have demonstrated a 50 to 80% volume reduction for thyroid nodules treated with RFA with improvement or resolution of compressive symptoms. In cases of hyperthyroidism, the ablation of hyperfunctioning thyroid nodules can help patients get off or reduce medications to reduce their thyroid hormone levels.

Ultrasound-guided RFA is appropriate for patients with benign (noncancerous) thyroid nodules who would prefer to avoid surgery or are not surgical candidates. Fewer patients undergoing RFA need thyroid hormone replacement after the procedure when compared to those undergoing thyroid surgery. RFA has a similar complication rate to thyroid surgery performed by a high-volume thyroid surgeon.

RFA is best indicated for patients with:

Benign nodules that are:
- Noticeable on swallowing
- Readily observable
- Causing compressive symptoms — pain, dysphasia, foreign body sensation, discomfort, cough
Hyperfunctioning, benign thyroid nodules

Thyroid nodules that are less than 4 centimeters and have no concerning biopsy features have the best results with RFA. You may need multiple biopsies to determine if the nodule is concerning for cancer before you can safely have RFA.

How Thyroid RFA Works

Our endocrine surgery team uses an ultrasound machine to guide the insertion of a needle electrode into the thyroid nodule. This allows the surgeon to heat the nodule precisely. Heating the nodule destroys the thyroid tissue and reduces the blood flow to the nodule, ultimately decreasing the size and function of the cells in the nodule.

The procedure takes about an hour. You will be given an oral medication to help with procedural anxiety and be treated with a local anesthetic before starting the procedure. Most people will experience some discomfort during the procedure, but that discomfort goes away once the procedure is done.

After the procedure, we watch you for an hour before going home that same day. You may resume normal activities, but will need someone to drive you home after the procedure.

Follow-up care includes neck ultrasounds at three-month intervals for at least one year after the procedure.

Benefits of Thyroid RFA

Thyroid RFA is a nonsurgical option with no scarring and a quick recovery. It can result in the improvement or complete resolution of hyperthyroidism for hyperfunctioning thyroid nodules. The procedure does not eliminate surgery as an option should you need it in the future.

Most patients see an increase in the size of their nodules right after the procedure due to swelling, so do not be alarmed if this happens to you. The nodule will start to decrease in size about a month after procedure. The reduction in size ranges from 40 to 90% in the nodule volume. This reduction peaks at about a year after the procedure, with some patients noticing continued reduction up to three years after the procedure.

Thyroid RFA Risks

After the procedure, you may experience a decrease in thyroid tissue function, so you may need thyroid replacement medication. While the procedure is safe, there are risks with anything. RFA risks include bleeding and injury to laryngeal nerves (vocal cord nerves).

We want to understand your goals of treatment and will review all of your treatment options so that you can make the best decision to achieve your treatment goals. In some cases, RFA is not an option or may not achieve all your treatment needs. RFA is contraindicated in pregnancy or if you have a pacemaker/defibrillator.

Getting Started

Froedtert Hospital is one of a select few in the region to offer this innovative treatment option. Our team will work closely with you throughout the treatment process, including navigating insurance coverage.

Please contact us to discuss your candidacy for thyroid RFA.