What are Thyroid Nodules?
Thyroid nodules are abnormal growths of thyroid gland tissue. This glandular tissue has lost its ability to self regulate and grows larger than its surrounding. Sometimes the nodule is large enough to impact the voice, swallowing function, or cause a visible lump in the neck. About 10% of nodules turn out to be thyroid cancer, so they must be taken seriously. Thyroid nodules are most commonly measured and evaluated by ultrasound in a thyroid surgeon‘s or endocrinologist‘s office. Nodules of a certain size are usually recommended for biopsy. Bloodwork may be done as well. Biopsy of a thyroid nodule may be done at the same time with a small needle technique called “fine needle aspiration.” Nodules that are benign may be monitored or removed.
Radiofrequency Ablation of Thyroid Nodules
Until recently, removal of the thyroid nodule was basically just done by surgery on the thyroid gland, which includes a neck incision and risk to important nerves of speech and swallow. Many patients also require thyroid replacement medicine after thyroid surgery.
Radiofrequency ablation (RFA) is a newer technique of treating thyroid nodules, typically causing nodules to shrink to insignificant size after a few months. The procedures uses a hand-held electrical device in the office (or sometimes a surgery facility) and takes about 45 minutes. This technique is accepted for treating thyroid gland nodules that are benign but are causing symptoms. In some areas, low-grade thyroid cancers and hyperthyroid nodules are being treated with ablation.
Anti-inflammatories or mild pain medication may be used for 1-3 days after the procedure. There is usually no impact on swallowing function or voice after the procedure. The breakthrough of using minimally invasive radiofrequency ablation can limit the need for open or robotic surgery to treat the thyroid gland. It also practically eliminates the risk of needing to take thyroid replacement medication after treatment.
Patients are carefully selected for this procedure. We typically will recommend this on patients with nodules causing symptoms or nodules that are visibly conspicuous. We also insist that you have had two separate biopsy procedures done on the nodule confirming absence of cancer. One or two ultrasounds are done in follow-up of the procedure several months later to measure response.
Radiofrequency energy uses very rapidly oscillating electrical current to disrupt the cells and molecules of the nodule. This particular RFA device has a specialized temperature monitoring and cooling system to ensure no collateral injury to surrounding tissue. RFA procedures have been in use in medicine for decades, but only recently applied to the treatment of low risk thyroid nodules.
For many people, thyroid nodule ablation with RFA will eliminate the need for surgery. After all, most thyroid surgery is performed for nodules that turn out to be noncancerous. You will need an indepth physician exam and review. We perform biopsies ahead of time, ultrasound guidance, and even do genetic testing analysis on nodules to properly identify cancer ahead of time. Before radiofrequency ablation, the only choice was to perform surgery for a large nodule that was causing symptoms.
After the RFA procedure, a few days recovery doing light duty is usually needed along with anti-inflammatories. We will reassess the nodule size at 3 and 6 months typically. For patients travelling to Atlanta for the procedure, we recommend a one-night stay in a local hotel with a loved one. We will schedule followup visits for 2 weeks and six months after the procedure.
Currently most of the major insurers are not covering this procedure. We are starting to see some Blue Cross Plans review their policies about this (which is a good sign!) and some Cigna policies are providing coverage. We would expect improving coverage in in the future. Out-of-pocket prices for RFA are around $4400 right now.
How Can I Schedule Thyroid RFA?
A consultation is required with one of our surgeons to review your case and see if this procedure is right for you. We will need some access to any prior thyroid biospy results you have. We are able to perform a repeat biospy if needed during the consultation visit.
Surgery is a great answer for many people. However the truth this, about 90% of surgery on the thyroid gland is done for noncancerous growths. Using ablation to eliminate the nodule without surgery will save people a lot of healing time, possible complication, and possible need for thyroid medication. This is an answer for people who have a troublesome noncancerous nodule.
Yes! Our office does hundreds of thyroid and parathyroid surgeries a year. Traditional thyroid surgery is still the most common management for questionable nodules, and we do a lot of it. However, RFA treatment of many nodules will be a game changer. We expect that almost half of thyroid nodules could be safely treated with RF ablation technology.
Radiofrequency ablation is done under local anesthesia. We go to great lengths to numb the neck at the onset of the procedure. Discomfort is minimal during the procedure. Afterwards an ice pack and some nonsteroidal anti-inflammatories are recommended for couple of days. Most patients do not need strong pain medication, and can return to most normal activities.
Many times we are not certain of the exact classification of a thyroid nodule until we have done surgical removal. However the needle biopsy, along with genetic testing, is very good at ruling out cancer. Benign thyroid nodules include follicular and papillary adenoma. There has been some research on RFA of very early low-grade papillary carcinoma, as well as hyperfunctioning nodules (hyperthyroid).
You will meet with a thyroid surgeon for consultation. We absolutely will need to have any prior needle biopsies that you have had done before. If we do not have any we may be getting new needle biopsies done. We aim to be 110% certain that there is no carcinoma or cancer in your thyroid before we do this procedure. We may have to have some thyroid blood work drawn as well. After we ensure you are medically appropriate for the procedure, we can get the procedure set up with our scheduling staff. We usually schedule 60-90 minutes for the treatment visit. Most patients will have a loved one drive them. If you are traveling from out of town, we do recommend spending at least 1 night in the Atlanta area for returning home.
There are 1 or 2 insurances in our market that are covering thyroid nodule ablation. We will check with your insurance to see if this service is covered. Most insurances are not covering yet. Many times with out-of-pocket deductibles and co-pays, patients may be paying more out-of-pocket to have a service covered by insurance anyway. Let us check for you.
Scientific Studies on Thyroid Nodule RFA:
- Muhammad, H., Santhanam, P., & Russell, J. O. (2021). Radiofrequency ablation and thyroid nodules: updated systematic review. Endocrine, 72(3), 619–632. https://doi.org/10.1007/s12020-020-02598-6
- Feroci, F., Guagni, T., Coppola, A., Perini, D., Conforti, B., Genzano, C., Belliti, D., Petrucci, A., Sarno, A., & Cantafio, S. (2020). Radiofrequency Thermal Ablation of Benign Thyroid Nodules: The Correlation Between Ultrasound Nodule Characteristics and Results. Surgical innovation, 27(4), 342–351. https://doi.org/10.1177/1553350620913134
- Rangel, L., Volpi, L. M., Stabenow, E., Steck, J. H., Volpi, E., Russell, J. O., & Tufano, R. P. (2020). Radiofrequency for benign and malign thyroid lesions. World journal of otorhinolaryngology – head and neck surgery, 6(3), 188–193. https://doi.org/10.1016/j.wjorl.2020.07.002
- Offi, C., Garberoglio, S., Antonelli, G., Esposito, M. G., Brancaccio, U., Misso, C., D’Ambrosio, E., Pace, D., & Spiezia, S. (2021). The Ablation of Thyroid Nodule’s Afferent Arteries Before Radiofrequency Ablation: Preliminary Data. Frontiers in endocrinology, 11, 565000. https://doi.org/10.3389/fendo.2020.565000