Ultrasound-guided radiofrequency ablation (RFA), a minimally invasive alternative to thyroid surgery, has been used internationally to shrink large, benign thyroid nodules for more than a decade. But only in recent years has there been growing interest in the U.S. in this procedure, typically performed by endocrinologists, radiologists, and otolaryngologists.
Explore This IssueMarch 2022
“As a thyroid surgeon, I became aware of literature that arose in Asia and Europe, where radiofrequency ablation has been used for many years for the thyroid gland,” said Gregory W. Randolph, MD, a professor of otolaryngology–head and neck surgery, director of the thyroid and parathyroid endocrine surgical division, and the Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology at Harvard Medical School in Boston. “In reviewing that material, it became apparent that this is something that might be worthwhile to introduce in the United States.”
Benefits of Radiofrequency Ablation
RFA has many benefits as a nonsurgical alternative to shrinking benign thyroid nodules greater than 2 cm, according to Lisa A. Orloff, MD, director of the Endocrine Head and Neck Surgery Program and a professor in the department of otolaryngology, division of head and neck surgery, at the Stanford University School of Medicine in Stanford, Calif. Dr. Orloff’s clinical practice focuses on the surgical management of thyroid and parathyroid tumors and disorders.
One of those benefits is that there is no absolute upper limit to the size of nodule that can be treated, and success is greatest for smaller nodules that are still greater than 2 cm. “Its appeal lies largely in avoiding loss of an entire thyroid lobe for the sake of treating a nodule, and there’s no surgical scar,” said Dr. Orloff. RFA is usually an office-based procedure, done under local anesthesia, with a recovery time of one to two days. It typically takes between 20 and 40 minutes.
Hemithyroidectomy is typically recommended for treatment of a symptomatic and/or enlarging cytologically benign thyroid nodule, and this is associated with an approximately 20% to 25% chance of resultant hypothyroidism requiring thyroid hormone therapy, said David L. Steward, MD, the Helen Bernice Broidy professor and chair of the department of otolaryngology–head and neck surgery at the University of Cincinnati College of Medicine. With RFA, Dr. Steward estimates that the chance of resultant hypothyroidism drops to about 5% or less, which is a significant motivator for patients.
The minimally invasive technique, which involves the insertion of a needle into the thyroid nodule, delivering ablation energy to alter the nodule, is tolerated very well by patients, said Dr. Randolph. As the nodule heals in the ensuing months, shrinkage occurs in the treated areas. “You can get volumetric reductions of 60% to 90%,” he said, which usually results in improvement in both symptoms and any cosmetic issues the patient was experiencing.