In patients who have one sided disease less than 50 ml of thyroid nodule volume, one treatment is very successful. For safety reasons, patients who have two sided disease will require two separate treatment sessions. Patients who have disease greater than 50 ml may elect to undergo surgery or can be treated in two sessions about 12-18 month apart.
On the day of the treatment we do not advise returning to work. The day after your therapy you will be examined to inspect the treated area with ultrasound. You may return to work following that brief visit.
Some patients have hyperthyroidism related to a nodule with autonomous function (AFTN). Autonomously functioning thyroid nodules can create symptoms of fatigue and rapid heart rate. The determination of AFTN is optimally made with an I131 Iodine Uptake Scan to show increased iodine uptake in the nodule compared to the remainder of the gland. This alternative therapy destroys these nodules with RFA, avoiding both surgery and hypothyroidism. Restoration of normal thyroid function is accomplished in most patients. No daily thyroid medications are required after Thyroid RFA of AFTNs!
Hyperthyroidism caused by Grave’s disease is not managed with this therapy.
Pregnancy, active coronary disease, prior neck irradiation, prior thyroid or lymph node malignancy, and anti-coagulation therapy. Thyroid nodules extending deep to the clavicle are only partially treated with this approach.
Unless the nodule is an autonomous functioning nodule (rarely malignant), two individual biopsies are required to conclude that a lesion is not cancer. With Thyroid RFA the nodule is not removed and sent to the pathologist for analysis. After RFA therapy, surveillance ultrasound might identify irregularities within the nodule which could be interpreted as suspicious. This interpretation may prompt further biopsies. Tissue cytology may look more atypical after RFA treatment . For that reason the assurance of benign thyroid tissue is critical prior to therapy.
Hypothyroid patients are not ideal candidates for RFA thyroid. Prior thyroid surgery patients already have a neck incision. Those with indeterminate biopsies (AUS or FLUS) without genetic testing will require further testing. Thyroid cancer patients and those with follicular lesions are not currently candidates for RFA thyroid at the Thyroid Nodule Treatment Center