- Bernardi et al, (2016) Radiofrequency ablation for benign thyroid nodules, J Endocrinol Invest, epub 16 February 2016
- Chen et al, (2016) Radiofrequency ablation for the treatment of benign thyroid nodules. A PRISMA-Compliant Systematic Review and Meta-Analysis of Outcomes. Medicine (2016) 95:34
- Kim,J-H et al, 2017 Thyroid Radiofrequency Ablation Guideline: Korean Society of Thyroid Radiology Korean J Radiol 2018; 19 (4):632-655
- Thyroid RFA Patient Guide – click to download
- Video: Thyroid Nodule Radiofrequency Ablation Lecture to Surgeons with Richard Harding, MD, FACS
Radiofrequency ablation (RFA) is a targeted therapy which uses electric energy and heat to destroy the abnormal tissue. RAI is Radioactive Iodine therapy which involves ingesting the radioactive tablet containing the radioactive iodine. This is taken up by all thyroid tissue including the enlarged and hyperfunctioning nodule. The radioactive energy destroys the genetic elements in the thyroid cells and eventually destroys the tissue. Hypothyroidism is a common problem after RAI, but not RFA.
Determination of therapy after a biopsy result may be complex. The evaluation of tissue on slides may not always determine if the tissue is benign. Surgical removal of the nodule for further analysis is appropriate therapy. For patients interested in a nonsurgical approach, the nodule can be further studied with genetic classification testing. This is an added expense and may determine if a nodule is benign. In this situation the appropriateness of RFA therapy can be considered. Some nodules may still require surgery in order to determine their innate behavior. If a scar-less approach is preferred, than Dr. Harding can discuss an endoscopic technique to remove the thyroid gland which leaves no visible scars. Currently he is the only surgeon in Arizona who is trained and experienced with this endoscopic trans-oral approach.
The effectiveness if therapy is partially measured by nodule volume reduction as well as preservation of normal thyroid function. The international data for nodule reduction has been overwhelmingly favorable for nodule reduction during the immediate months after therapy. We aim for a 60% reduction in volume at 3 months and a 90% volume reduction in one year. The success of the ablation is determined by the amount of energy applied in each nodule as well as the precision of the delivery. Expertise in ultrasound guided therapies is therefore a requirement to perform these challenging procedures.
Usually oral Tylenol and/or Ibuprofen are adequate after ablation. Taking a mild anti-anxiety, anti-spasm medication tablet such as Valium prior to the procedure can improve the level of comfort during the procedure as well.
A wide-field cervical nerve plexus block is performed with a local anesthetic. This field block is performed using local anesthesia and US guidance. This effectively numbs the anterior neck and capsule of the thyroid where the nerves are present. Because the internal aspect of the thyroid gland has no sensation, the treatment can be performed with little pain.
Optimal therapy includes communication with the patients during the procedure. General anesthesia is less desirable because the patient cannot speak. Under local anesthesia, we are still able to converse with the patient to assess the quality of the voice. Although rarely necessary, interventions to protect the recurrent laryngeal nerve can be initiated should the patient’s voice becomes weak or hoarse.