Thyroid Radiofrequency Ablation (RFA) for Benign Thyroid Nodules

Thyroid nodules, even when benign (non-cancerous), can grow visibly large and cause swallowing or breathing difficulties, persistent cough, and hoarseness. Radiofrequency Ablation (RFA) and Microwave Ablation (WMA) are a non-surgical treatment option that can reduce the size of thyroid nodules and restore thyroid function. RFA and MWA are minimally-invasive technique performed by an endocrine surgeon guided by ultrasound imaging. The physician delivers targeted radio waves that disrupts the nodule’s cells, causing them to shrink as the body absorbs the ablated tissue.

Thyroid RFA Procedure - Saint Johns Cancer Institute

Thyroid Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) for small thyroid cancers

Most micropapillary (under 1 cm) thyroid cancers are slow growing, and very low risk. Your doctor will generally discuss three treatment options with you, depending on the specific ultrasound characteristics of your cancer.

Thyroid Lobectomy: we remove the half of thyroid that contains the cancer.
Active Surveillance: we keep an eye on your tumor with regular ultrasounds to make sure it does not grow or change (do not operate).
Thermal Ablation with RFA or MWA: we perform a very short RFA or MWA procedure in the clinic with the goal of ablating the entire tumor plus a little of the surrounding normal tissue. We monitor your cancer with regular ultrasounds and expect the cancer to disappear over time.

Why Choose RFA or MWA instead of surgery?

Thyroid RFA or MWA are non-surgical treatments for thyroid nodules. It greatly reduces the need for nodule surgery and the use of Radioactive Iodine (RAI). While surgery results in a visible scar, the RFA or MWA procedure is minimally invasive and a safe and relatively quick treatment option. RFA and MWA enable patients to resume normal daily activity immediately with minimal recovery time. While surgery may involve removing part of the thyroid, RFA maintains thyroid integrity, which supports improved thyroid function.

RFA and MWA have been proven to reduce the size of thyroid nodules.

**2019 RFA Published Findings for Thyroid – Rate of Nodule Reduction According to Size¹**
	6 months	1 year	2 years	3 years	4 years	5 years
All nodules	56.2%*	63%*	67.4%*	66.7%	66.9%	66.9%
Less than 10 mL in size	79%*	78%	76.8%	76.8%	75%	81.8%
Greater than 10 and less than 20 mL in size	59%*	66.7%*	74.2%*	74.2%	70%	74.5%
Greater than 20 mL in size	54.5%*	60.9%*	62.4%*	62.4%	62%	65.3%

*Rate of reduction was calculated with respect to the baseline volume.

The term radiofrequency (RF) refers to an alternating electric current oscillating between 200 kHz and 1200 kHz. Application of radiofrequency in a medical setting agitates tissue ions as they attempt to follow the changes in direction of the alternating current, thereby creating frictional heat around the electrode. The heat generated from the emitter affects the immediate tissue, which is only within a few millimeters of the electrode tip. RF has been used as a medical treatment successfully for many parts of the body including the spine, liver, colon, and prostate.

The term Microwave (MW) refers to electromagnetic waves that move water molecules, causing friction and heat that in turn destroys neighboring tissue and tumor cells.MW has been used as a medical treatment successfully for many parts of the body including the liver, lung, and bone.

Listen to Dr. Melanie Goldfarb discuss RFA for Thyroid

Dr. Melanie Goldfarb, Director, Center for Endocrine Tumors and Disorders, and Associate Professor of Surgery at Saint John’s Health Center discusses this novel RFA procedure.

Benefits of Thyroid Radiofrequency Ablation and Microwave Ablation

Clinical trials involving RFA and MWA for benign thyroid nodules have shown a reduction in size by 51-85% within the first six months. In most patients, nodule related symptoms were significantly improved or had disappeared. Similar results were seen for thyroid function, such as normalizing blood-hormone levels for patients that presented with a toxic hormone-producing thyroid nodule.

A minimally-invasive procedure
Preserves your healthy thyroid tissue and allows it to function normally without the need for a lifetime of medication
Performed under local anesthesia as an out-patient procedure (no downtime or hospitalization)
Shorter recovery time
No visible scarring
Reduced the volume of the nodule with a low complication rate
Improves quality of life

What to expect during RFA and MWA treatment

Dr. Melanie Goldfarb performs ultrasound imaging, examining the size of thyroid nodules

About an hour prior to the procedure, or upon check-in, patients are typically given a low-dose sedative to help them relax. A local anesthetic is applied externally to the treatment area around the thyroid gland. Patients will sometimes doze off during the procedure or may choose to listen to music.

Once the patient is relaxed, the doctor positions a thin needle into the nodule under continuous ultrasound guidance. Radiofrequency or microwave energy is emitted from the tip of the needle which causes very precise erosion of the targeted tissue. The physician systematically guides the instrument through the entire nodule, treating as much of the inner volume as is safe to do so. Patients can expect to go home fairly quickly after the procedure. Any post-treatment discomfort is easily managed with an orally-taken pain reliever (acetaminophen).

Risks of Thyroid RFA and MWA

All medical treatments and procedures have risks which will be discussed in detail with you or your family member. Serious complications are rare with the RFA and MWA procedure because it is a minimally-invasive, out-patient procedure. Bleeding, hoarse voice (due to nerve bruising), skin burns, and infection are possible, but with safety and best practices protocols for RFA and MWA, side effects can be effectively mitigated, including localized swelling and redness. Though infection can be a very rare problem, it will be continuously monitored by the treating physician and clinical team.

Why is it important to maintain a healthy thyroid?

Our brain, heart, digestive, and metabolic systems function normally with the help of the thyroid gland. It is a butterfly-shaped organ located at the front of the neck near the base of the throat, wrapping around the windpipe. The thyroid gland is part of the endocrine system, where it secretes hormones to regulate the body’s heart rate, blood pressure, temperature, and metabolism.

Additional complications can involve the esophagus, trachea, and nerves that surround the vocal cords. The risk of permanent injury to these areas is extremely rare. Larger nodules may require multiple RFA or MWA treatments for effective nodule shrinkage, which can increase risk. Your doctor will discuss the likelihood of needing additional treatments with you during your initial assessment.

¹Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, Volume 104, Issue 9, September 2019, Pages 3939–3985
https://doi.org/10.1210/jc.2019-01338

If you have questions regarding RFA treatments for benign thyroid nodules, please call today. Request an appointment

310-829-8751

Melanie Goldfarb, M.D., M.Sc., FACS, FACE

Director, Center for Endocrine Tumors and Disorders
Medical Director for Cancer Survivorship

Dr. Melanie Goldfarb is a fellowship-trained endocrine surgeon and Director of the Center for Endocrine Tumors and Disorders. Her expertise is minimally invasive surgery for thyroid cancer and disorders, hyperparathyroidism, and adrenal tumors, including pheochromocytoma, Cushings, Conns, and adrenal cancer.