Thyroid Nodule Symptoms and Treatment, RFA

A thyroid nodule is a growth or lump that forms within the thyroid gland, which is located at the front of the neck. These nodules can be solid or filled with fluid and are often discovered during a routine physical exam or imaging test, such as an ultrasound. The majority of thyroid nodules are benign, meaning they are not cancerous, but a small percentage may be malignant.

Thyroid Nodule Symptoms

Some people may not notice any symptoms, while others may experience swelling in the neck, a visible lump, difficulty swallowing, or changes in their voice. It is important to evaluate any thyroid nodule to determine if it poses a risk and what the most appropriate next steps may be. Depending on factors such as size, symptoms, and biopsy results, treatment options may range from simple observation to various procedures or medication.

Thyroid Nodule Treatment

Thyroid nodule treatment varies depending on several factors, including whether the nodule is benign or malignant, its size and the presence of symptoms or changes in thyroid hormone levels. If you have small, benign nodules that do not cause symptoms, watchful waiting with regular monitoring through ultrasound and physical exams may be appropriate.

Surgery is generally reserved for nodules that are suspicious or confirmed to be cancerous, or for those causing significant symptoms that affect quality of life. Your care team will work with you to consider the specific risks, benefits, and goals associated with each approach, ensuring that you receive a treatment plan tailored to your diagnosis and preferences.

Thyroid Radiofrequency Ablation (RFA)

Thyroid RFA is an outpatient procedure that allows for the destruction of thyroid cells within a nodule with the use of a needle-like probe. It provides patients with a nonsurgical treatment option to shrink the nodule while preserving unaffected normal thyroid tissue. Clinical studies in Europe, Asia and the U.S. have demonstrated a 50 to 80% volume reduction in the thyroid nodule over the course of a year after RFA with improvement or resolution of compressive symptoms. In cases of hyperthyroidism, the ablation of hyperfunctioning thyroid nodules may 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 that are causing symptoms, who would prefer to avoid surgery or are not surgical candidates.

Compared to those who undergo thyroid surgery, the need for thyroid hormone replacement is lower in patients undergoing RFA. 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

You may need multiple biopsies to confirm that the nodule is benign 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 20 minutes before going home that same day. You may resume normal activities, but you 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 of symptoms 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.

Many patients have some degree of swelling after the procedure, so do not be alarmed if this happens to you. The nodule will typically start to decrease in size about a month after the procedure. The reduction in size ranges from 40 to 90% in the nodule volume. This reduction peaks at about one year after the procedure, with some patients noticing continued reduction up to three years after the procedure.

Thyroid RFA Risks

While the procedure is safe, there are risks with any procedure. RFA risks include bleeding, injury to laryngeal nerves (vocal cord nerves), pain, skin or tracheal burn, and nodule rupture.

We want to understand your goals of treatment and will review all your treatment options so that we can make the best decision to achieve your 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.