Radiofrequency Ablation (RFA) for Thyroid Nodules: A Safer Alternative

Those seeking treatment for thyroid nodules now have a less invasive alternative to surgery – radiofrequency ablation (RFA).

RFA, now available at UPMC, is an in-office procedure that shrinks nodules, relieves associated symptoms, and improves cosmetic appearance.

The therapy often takes less than an hour, requires only local anesthesia, and allows you to return home the same day.

Here’s what to know about RFA.

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What Is Radiofrequency Ablation (RFA)?

Radiofrequency ablation, or RFA, uses high-frequency radio waves to create heat that destroys thyroid nodules’ cells.

Doctors place a probe into the nodule and turn on the radiofrequency current.

The treatment is for large, benign thyroid nodules, or non-cancerous growths, on the thyroid. The thyroid is a gland in the front of the neck that releases hormones.

Nodules may cause issues with speaking, swallowing, and breathing. RFA can reduce and even stop symptoms like voice hoarseness, pain, and swallowing problems.

“It’s a less-invasive procedure to treat large thyroid nodules,” says Elena Morariu, MD, an endocrinologist in UPMC’s Endocrinology Division. “We focus primarily on large nodules that cause either a cosmetic concern or local symptoms. Maybe they’re affecting other structures or they’re producing too much thyroid hormone, which can cause hyperthyroidism.”

After the procedure, the growth will gradually shrink over the course of three to six months.

Benefits and Risks of RFA

RFA is more specific in its targeting and less invasive than surgery to remove a large thyroid nodule.

“Surgery carries the risk of impacting thyroid function and needing to go on thyroid hormone because we’re removing other tissue with the thyroid nodule,” says Dr. Morariu.

“RFA spares normal thyroid tissue and preserves thyroid function. It can also normalize thyroid function through treatment of the nodule if the nodule is producing excess hormone. It’s lower risk than surgery with general anesthesia, and recovery time is shorter.”

People who undergo RFA are more likely to maintain their thyroid function compared to those who get surgery to remove thyroid nodules.

As with most health treatments, complications can occur with RFAs.

Still, serious side effects are rare.

Rare risks include:

  • Bleeding.
  • Infection.
  • Nerve injuries that can cause a hoarse voice, which is usually temporary.
  • Nodule rupture.
  • Skin burns.

Thyroid nodules may grow back and require another treatment.

“In most cases, it should be one single procedure, and then the nodule slowly shrinks,” says Dr. Morariu. “But in some cases, in larger nodules particularly, more than one procedure may be necessary to achieve good results.”

A doctor can help you weigh the benefits and risks of RFA based on your individual needs.

Candidates for RFA

Ideal candidates for RFA may include people with large, non-cancerous thyroid nodules that are:

  • Causing symptoms such as difficulty swallowing or breathing.
  • Cosmetically concerning.
  • Producing excess thyroid hormone, or hyperthyroidism.

“We wouldn’t do this in nodules that are not causing any problems,” says Dr. Morariu. “So, if a person is completely asymptomatic, there isn’t a need to do this procedure.”

Doctors will perform RFA only on benign thyroid nodules they’ve biopsied. “We recommend twice, in most cases, to make sure that we’re treating a benign nodule and not a potential cancer that would be better treated with surgery,” says Dr. Morariu.

What to Expect During RFA Treatment

Preparing for your RFA

Preparation for an RFA is “minimal,” says Dr. Morariu.

Generally, you don’t need to go on a special diet ahead of time. You may get medication to help with relaxation before the procedure if necessary. You’ll have to change into a surgical gown for the appointment and remove all metal items from your person.

If you take blood thinners, your doctor may ask you to stop a few days before the procedure. This is because RFA can cause bleeding in rare cases.

Often, you can restart the medications a day after the procedure.

Also, tell your doctor if you have any implants such as pacemakers or defibrillators, or if you’re pregnant.

During your RFA

The procedure usually takes about an hour.

During the appointment, you’ll lie down and receive local anesthesia, or pain medicine. This is instead of general anesthesia, which means you’ll find you’re awake and can speak throughout.

During an RFA:

  • Your doctor will use an ultrasound wand to place the probe or needle into the thyroid gland.
  • Your doctor will then turn on the radiofrequency waves to shrink the nodule.
  • You may feel slight discomfort, pressure, or tingling, but the anesthesia will ensure you don’t feel pain.

Recovering from your RFA

Immediately after the procedure, you’ll receive a cold pack to reduce swelling to the area. You’ll also remain at the clinic for about an hour for monitoring. Before you head home, your care team will tell you how to care for the wound and spot any signs of complications. Minor swelling and pain are common in the first 24 hours and can last several days. During this time, you can:

  • Rest and use cold compresses.
  • Take over-the-counter pain medicine, such as acetaminophen, under your doctor’s guidance.

Most people get back to their daily routine within a day or so, says Dr. Morariu.

“There may be some swelling, pain, and discomfort in the days following the procedure, but otherwise, recovery time and restrictions are minimal,” says Dr. Morariu. “We advise people to avoid strenuous physical exertion for several days following the procedure, but recovery is pretty quick.”

As your immune system removes the dead nodule cells over the course of weeks and months, you should begin to notice nodule shrinkage and improved symptoms.

UPMC’s Endocrinology Division experts can diagnose and treat a wide variety of thyroid concerns. Call 412-586-9700 or find an endocrinology location near you for more information.

About Endocrinology

The UPMC Department of Endocrinology stands as a national leader in research of diabetes and endocrine conditions. We partner with the University of Pittsburgh Division of Endocrinology and Metabolism for research and clinical trials. We treat diabetes, obesity, osteoporosis, hormonal disorders, and thyroid disorders at several locations across our communities. We also have specialized Diabetes Centers to help you manage your disease. Find an expert near you.