Non-Surgical Treatment Options for Benign Thyroid Nodules
Radiofrequency Ablation for Benign Thyroid Nodules
Radiofrequency ablation (RFA) is a minimally invasive, non-surgical treatment that can reduce the size of certain benign thyroid nodules. It may be considered when a nodule is causing symptoms or cosmetic concerns and the patient and care team determine that ablation is an appropriate alternative to observation or surgery.
RFA is not a treatment for a thyroid nodule simply because it is present or because a patient wants to avoid surgery. Careful evaluation is important because RFA treats the nodule without removing it for surgical pathology.
What Is Radiofrequency Ablation?
RFA uses controlled radiofrequency energy to generate heat within targeted tissue. With continuous ultrasound guidance, a thin electrode is positioned within the thyroid nodule and energy is delivered to selected areas of the nodule.
The treated tissue is gradually reabsorbed by the body, causing the nodule to shrink over time. Unlike thyroid surgery, RFA does not remove part or all of the thyroid gland.
Who May Be a Candidate for Thyroid RFA?
RFA is intended for carefully selected patients with benign thyroid nodules. The American Thyroid Association recommends considering thermal ablation primarily for nodules causing compressive or cosmetic concerns that can be attributed to a single or dominant nodule. Appropriately selected autonomously functioning nodules may also be treated with thermal ablation.
There is no single nodule size that determines whether RFA is appropriate. The location and characteristics of the nodule, the symptoms it causes and the patient’s treatment goals all matter. Small benign nodules that do not cause symptoms generally do not require treatment.
- Benign thyroid nodule confirmed through appropriate biopsy evaluation
- Pressure, swallowing or other local symptoms attributable to the nodule
- Visible enlargement or cosmetic concerns
- Ultrasound characteristics appropriate for ablation
- A treatment plan developed through shared decision-making after considering observation and surgery as appropriate
Why Does a Nodule Need to Be Confirmed as Benign?
Unlike surgery, RFA does not remove the entire nodule for definitive histologic examination. Establishing a high level of confidence that the nodule is benign is therefore an important part of patient selection.
Two benign biopsies are usually recommended before RFA. In selected circumstances, a single benign biopsy may be sufficient, including some nodules with very low-suspicion ultrasound features and some autonomously functioning nodules. The appropriate approach depends on the nodule’s ultrasound appearance, cytology and clinical circumstances.
Ultrasound is also used to evaluate the nodule and surrounding neck structures and to help determine whether ablation is appropriate.
Learn more about thyroid nodules and their evaluation.
RFA Is Different From Thyroid Cancer Treatment
RFA for benign thyroid nodules should not be confused with treatment of thyroid cancer. A nodule that is suspicious for cancer, has indeterminate findings requiring further evaluation, or is confirmed to be malignant may require a different treatment approach.
For benign nodules, the goal of RFA is to reduce nodule volume and related symptoms or cosmetic concerns while preserving as much normal thyroid tissue as possible. Treatment decisions should be based on the individual diagnosis rather than on a general preference for surgical or non-surgical treatment.
What Happens During Thyroid RFA?
Thyroid RFA is performed as an outpatient procedure using local anesthesia and real-time ultrasound guidance. A thin electrode is inserted into the nodule, and controlled radiofrequency energy is applied to targeted tissue.
The physician continuously monitors the position of the electrode and the surrounding structures during treatment. Procedure time varies with the size, composition and location of the nodule and the treatment plan.
What Does RFA Feel Like?
Patients remain awake during the procedure and receive local anesthesia to numb the treatment area. Pressure, warmth or temporary discomfort may occur, and patients should tell the treatment team if they are uncomfortable.
What Are the Potential Benefits of RFA?
For appropriately selected patients, RFA can reduce the size of a benign thyroid nodule without removing the thyroid gland. Nodule shrinkage occurs gradually, and reduction in volume can lessen symptoms or visible enlargement when those concerns are caused by the nodule.
- Preservation of the thyroid gland
- No surgical incision in the traditional sense
- Local rather than general anesthesia in typical cases
- Outpatient treatment
- Gradual reduction in nodule volume
- Potential improvement in pressure, swallowing or cosmetic concerns related to the nodule
- Generally shorter recovery than thyroid surgery
These benefits do not mean that RFA is preferable to surgery for every patient. Some nodules are better treated surgically, and some require no treatment at all.
How Much Will the Nodule Shrink?
RFA does not make a nodule disappear immediately. The treated tissue is gradually reabsorbed, so the reduction develops over weeks and months. Published studies have demonstrated substantial and durable reductions in benign thyroid nodule volume, although the degree of shrinkage varies among patients and nodules.
In a five-year observational study of 215 patients, the average nodule-volume reduction was approximately 67% at five years after a single RFA treatment. Smaller nodules had greater average volume reductions, while larger nodules tended to shrink less and may require additional treatment to achieve the desired result. Individual results can differ.
Symptoms and cosmetic concerns may improve as the nodule becomes smaller, but improvement is not guaranteed and depends on the cause and extent of the patient’s symptoms.
Will RFA Change Thyroid Function?
Because RFA treats targeted portions of a nodule while preserving the surrounding thyroid, many appropriately selected patients maintain normal thyroid function after treatment. However, preservation of thyroid tissue does not guarantee normal thyroid function in every patient.
Patients who already have hypothyroidism or autoimmune thyroid disease may continue to need thyroid hormone medication. Thyroid function can be monitored when clinically appropriate as part of follow-up care.
What Is Recovery Like After RFA?
RFA generally has a shorter recovery than thyroid surgery because the thyroid gland is not surgically removed and general anesthesia is typically not required. Temporary neck soreness, tenderness, swelling or discomfort with swallowing can occur after treatment.
Patients receive individualized instructions about activity, medications and follow-up. Follow-up commonly includes assessment of symptoms and ultrasound measurement of the treated nodule, with thyroid-function testing when indicated.
What Are the Risks and Limitations?
Although RFA is minimally invasive, it is still a medical procedure and is not without risk. Potential complications include pain, bleeding, infection, skin injury, voice changes related to nerve irritation or injury, and other injury to structures near the thyroid. Rare complications can be serious.
RFA also has limitations. It does not provide the same complete tissue removal and pathology examination as surgery. Some nodules may not shrink enough after one treatment, and larger nodules may require additional treatment. Careful patient and nodule selection, appropriate technique and follow-up are important to achieving safe and useful results.
RFA or Surgery—or Observation?
There is no single best treatment for every benign thyroid nodule. Observation with ultrasound may be appropriate when a nodule is not causing symptoms or cosmetic concerns. RFA may be considered when a benign nodule is causing symptoms or cosmetic concerns and the patient is an appropriate candidate. Surgery remains an important option when the diagnosis, nodule characteristics, symptoms or other clinical factors make it the better choice.
The decision should include a discussion of the potential benefits and limitations of each approach, including expected nodule reduction, recovery, risks, the need for follow-up and the possibility of additional treatment.
Learn more about thyroid radiofrequency ablation at Saint John’s.
Learn more about thyroid surgery and thyroidectomy.
Hear From Dr. Melanie Goldfarb
Dr. Melanie Goldfarb discusses radiofrequency ablation for thyroid nodules and how this minimally invasive treatment can fit into care for appropriately selected patients.
Dr. Melanie Goldfarb discusses radiofrequency ablation for benign thyroid nodules.
Thyroid RFA at Saint John’s
The Center for Endocrine Tumors and Disorders at Saint John’s evaluates thyroid nodules and discusses observation, RFA and surgery according to the patient’s diagnosis, ultrasound findings, biopsy results, symptoms and treatment goals.
Explore the Center for Endocrine Tumors and Disorders.
Learn more about Melanie Goldfarb, MD.
Sources & Further Reading
- American Thyroid Association — General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules
- Journal of Clinical Endocrinology & Metabolism — Long-Term Efficacy of a Single Session of RFA for Benign Thyroid Nodules
- Saint John’s Cancer Institute — Thyroid Radiofrequency Ablation