RFA is a cutting-edge technology for treatment of benign thyroid nodules. It is minimally invasive, scarless, and very safe alternative to surgery. It is performed in the doctor’s office under local anesthesia and ultrasound guidance. A needle is placed into the target. The needle is connected to an alternating electric field produced by an electrode needle connected to an external radiofrequency generator. This induces thermal injury to the target tissue leading to shrinkage of the thyroid nodule. The surrounding tissue is not affected therefore thyroid function remains normal.

The RFA procedure is a standardized procedure and follows a well-established protocol developed all over the world.

• Benign, biopsy proven, thyroid nodule that are symptomatic (cause anterior neck pressure, difficulty swallowing, voice change, continuous growth)

• Overactive thyroid nodules

• Large multinodular goiters

• Cosmetic concerns

• Nodules recommended to be removed but patients would either like to avoid surgery or are not good surgical candidates.

• Office procedure with no downtime

• Patient will return to their normal activity the next day

• Scarless

• >50% shrinkage of thyroid nodule

• Lower cost compared to surgery

• Very low complication rate

• Very low chance of hypothyroidism/requirement for thyroid medication

The procedure is very safe and complications are minimal (2.1%). Most common complications are:

• Transient voice loss: 1.45% with possibility of permanent voice loss of 0.17%.

• Nodule rupture 0.17% (sudden neck bulging and pain after the procedure

• Local bleeding, hematoma 1%

• Vomiting 0.62%

• Skin burns 0.28%

• Brachial plexus injury 0.07%

• Capsular rupture 0.14%

• Abscess with tumor rupture 0.07%

• Hypothyroidism, especially if TPO antibodies are positive 0.07%

• Skin burns

• Bruising after the procedure

• Surgery is needed for thyroid cancer or highly suspicious nodules

• Larger nodules/goiter extending posteriorly or into the chest area, or close to vital organs - calcifications that preclude advancement of the needle to the target areas

• Graves disease

Patient should have 2 benign thyroid biopsies for most nodules or 1 benign biopsy result for a nodule with benign characteristics on ultrasound based on the ATA/TIRAD criteria.

• 1 benign biopsy of a toxic nodule

• Need to be able to be off blood thinners

• Able to lie flat with neck extended for at least 30 minutes

• Absence of cardiac pacemaker or similar devices

• Ablated thyroid nodule decrease gradually in size several months to years

• For larger nodules more than one treatment will be needed to achieve a significant decrease in volume. An “iceberg” ablation approach is needed for larger nodules for sequential ablations.

• Close observation with US and laboratory evaluation is recommended at 6 weeks, 3 months and 6 months after RFA. Further monitoring will be determined by your physician.

• RFA is a much cheaper alternative to surgical procedure

• Cost varies depending on the setting performed. Hospital setting price varies substantially between $7000-25,000.

• The cost of the procedure in an office setting without insurance is approximately $5,000. The procedure is not yet covered by any insurance and is expected to be an out-of-pocket cost. HSA and Flex accounts can be used to pay for the procedure.