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Is Radiofrequency Ablation a Good Alternative to Surgery for Benign Thyroid Nodules? A Look at Benefits, Risks

by Renée Bacher •

Patient testimonials on Dr. Hand’s Facebook page (https://www.facebook.com/RadiofrequencyRFA) share stories and images that include a 75% reduction in nodule size three months post treatment with RFA with no loss of thyroid function and full resolution of cosmetic concerns. She also posts You- Tube interviews on the page to educate prospective patients with thyroid nodules about RFA.

“I was really surprised at the volume I was doing last year, but this speaks to how much patients wanted to avoid surgery,” she said. “They’re coming to me from thousands of miles away. I believe that, in the future, thyroid specialists who aren’t offering this may want to reconsider now. The last ones trained have the least amount of experience and will get the fewest referrals.”

Renée Bacher is a freelance medical writer based in Louisiana.

RFA Procedural Basics

RFA is usually performed in office, but the location can vary according to the practitioner’s preference and the patient’s need for comfort and safety. Here are the procedure basics, from the December 2021 multiconsensus statement on best practices in the use of RFA (Head Neck. 2022;44:633-660):

  • The patient lies on the table on his or her back, with the neck extended gently and the practitioner at the head of the table. The ultrasound (US) images on the screen will be inverted from this position. To avoid injury from conduction, the patient must have no metal on his or her body.
  • The practitioner places grounding pads distal to the neck and on both anterior thighs. The neck is cleansed, the field is draped, and the patient’s eyes may be covered to prevent injury. If the patient is anxious, a mild sedative may be administered. Vital signs are taken both before and after the procedure; if administering a sedative, blood pressure, heart rate, and pulse oximetry may be monitored. In case of the rare event of cardiac arrhythmia, it’s advisable to have an emergency crash cart and oxygen nearby.

The procedure comprises three basic components: local anesthesia, the trans-isthmic approach, and the moving-shot technique.

  • In brief, a local anesthetic is injected in the anterior neck at the RFA electrode insertion site based on baseline US assessment of the trajectories required to access the nodule to be ablated. Next, perithyroidal lidocaine injection is performed.
  • For treatment of a nodule in either the right or left lobe of the thyroid, the electrode is inserted via the isthmus in a medial to lateral direction. This approach allows the constant monitoring of the association between the electrode, the target nodule, and the vicinity of the recurrent laryngeal nerve. It also prevents possible injury by allowing the electrode position to remain stable even if the patient speaks, swallows, or coughs.
  • RFA thyroid nodule treatment employs a “moving shot” technique whereby the nodule is ablated in small, multiple units that are treated individually. Unlike using RFA to treat tumors in other organs, where the tip of the electrode is fixed at the center of the target, this technique is preferable for thyroid nodules, which are often protruding and elliptical in shape. Using a fixed technique makes them difficult to ablate and can either overtreat or undertreat the nodule and its adjacent tissue.