Radiofrequency Ablation: Modern Management of Thyroid Nodules

First, Gopi and David review workup of thyroid nodules. Before considering RFA, patients need thyroid function tests, ultrasound imaging, and a biopsy showing benign disease. In David’s opinion, radiofrequency ablation is a good option for benign nodules larger than two centimeters that are enlarging and causing compressive symptoms. RFA is not appropriate for malignant disease, with the potential application for papillary microcarcinoma, which is currently being evaluated in other parts of the world.

Next, David outlines how he performs RFA. Using a combination of mild sedation, local anesthesia, and regional anesthesia, he performs this procedure in-office under continuous ultrasound guidance. Radiofrequency ablation uses heat to cause coagulative necrosis of nodular tissue. After cervical block and anesthetization of the thyroid capsule, David introduces the RFA probe through a small midline neck incision. Drawing on the “moving shock technique,” he moves the RFA probe back and forth, watching for signs of tissue necrosis on ultrasound. Complications of RFA are similar to those of thyroid surgery, but they occur at lower rates due to the less invasive nature of this procedure.

Finally, the conversation places RFA in a larger context for the thyroid surgeon. RFA patients return to the clinic that same week for a physical exam. Surveillance ultrasounds occur six and twelve months post-procedure. David counsels his patients that their nodule will not shrink immediately, and may swell in the days following their procedure. However, he expects the nodule to shrink 50-80% in the year following RFA. The podcast wraps up with an overview of how to bring RFA to your practice.