Care at NUH

Radiofrequency Ablation Thyroid

Radiofrequency Ablation (RFA)

Radiofrequency ablation (RFA) of thyroid nodules is a non-surgical treatment to remove benign thyroid nodules. Thyroid nodules are abnormal lumps (growths) within the thyroid gland. They are common and are more frequently seen in women. These nodules can be solid, fluid-filled or a combination of both. Majority of thyroid nodules are benign (non-cancerous) but may be symptomatic. In some cases, they can grow and lead to issues such as breathing difficulties, swallowing issues, pain and discomfort. Although surgery is the most commonly employed treatment, radiofrequency ablation (RFA) treatment offers a non-surgical alternative.

Instead of conventional open surgery, radiofrequency ablation (RFA) treatment offers a non-surgical method to remove benign thyroid nodules. RFA involves shrinking the nodule by destroying the cells within it, alleviating symptoms such as pain, discomfort and neck lumps. In most cases, thyroid function is unaffected by the procedure. This non-surgical treatment is particularly suitable for patients with established benign thyroid nodules that may be symptomatic. Compared to an open surgery, patients who opt for RFA experience less downtime and a shorter recovery period. Most patients can return to work and resume their usual activities within a day of the procedure.

How is radiofrequency ablation (RFA) of thyroid nodule carried out?

This treatment involves the placement of a small probe about the size of an injection needle into the thyroid nodule. Thereafter, the tip of the probe is activated, generating a radiofrequency wave that heats up the nodule, effectively destroying the cells within the nodule.

This procedure may be performed under sedation, local or general anaesthesia. Local anaesthesia and sedation are preferred to allow better patient monitoring. The procedure lasts for 30-45 minutes, depending on the size of nodule for ablation. 

Local anaesthesia is administered to the neck to ensure there is minimal pain and discomfort during the procedure. Following this, cold fluid may be injected around the thyroid to prevent heat transmission to the surrounding structures. Thereafter, the RFA probe is inserted into the thyroid nodule under ultrasound guidance, and is activated to allow for thermal ablation of the nodule. 

How RFA procedure is done:
Radiofrequency ablation (RFA) procedure
RFA procedure details

Radiofrequency ablation (RFA) procedure involves the insertion of a small probe into the thyroid nodule. This can be done under local or general anaesthesia, or sedation. Patients typically experience minimal discomfort both during and after the procedure.

Activated RFA probe in the thyroid nodule:

Activated RFA probe

RFA probe being activated in the thyroid nodule, leading to thermal destruction of nodule with preservation of surrounding thyroid tissue.

Treatment outcomes

Radiofrequency ablation (RFA) of thyroid nodule was first conceptualised in 2006. Since then, the overall results have shown great efficacy in the shrinkage of thyroid nodules. In a systemic review involving 1,737 patients with a total of 1,943 thyroid nodules treated with RFA, 85% of patients achieved a target volumetric reduction of at least 50%. Most patients achieved approximately 67% to 93.6% volumetric reduction, these patients were followed up for a minimum of 18 months demonstrating long-term efficacy in this technique.

Who is eligible for radiofrequency ablation (RFA) treatment?

Presently, RFA is largely used in patients with benign thyroid nodules. This is established by performing two biopsies. Patients with predominantly solid nodules who are symptomatic would benefit most from RFA.

What can I expect after the procedure?

Most patients return home on the day of the procedure and are able to resume their usual daily activities the following day. Some patients might experience minor soreness or swelling over the ablated site, which typically resolves after about 72 hours.

Patients will have a one-week post-procedure follow-up via telemedicine, followed by a face-to-face review after three months. If any symptoms or concerns arise after the procedure, appointments will be arranged for further evaluation.

What are the potential side effects?

As this procedure involves the use of heat to ablate the thyroid nodule, there is a potential risk of heat transmission to the surrounding structures. This includes the nerves to the voice box, which may lead to hoarseness. Other potential side effects include the risks of thermal injury to the surrounding blood vessels and the overlying skin, which might result in bleeding and possible burns to the skin.

These side effects are generally uncommon, occurring less than 1% of the time, and are further prevented by administering cold fluid around the target area during the procedure.

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