The thyroid gland is small, but it has a big job. While it’s primarily responsible for controlling your metabolism, it ultimately affects nearly every part of your body. Like a car battery, we don’t usually think about the thyroid gland—until it stops working properly.
Thyroid nodules can affect how the thyroid functions. Even though the vast majority of nodules are benign and not life-threatening, they can still cause problems. Some benign thyroid nodules may cause discomfort, problems with swallowing, produce excess thyroid hormone and/or cause cosmetic concerns.
At Iowa ENT Center in West Des Moines, Iowa, we’re highly experienced at treating all types of thyroid problems. Dr. Simon Wright, one of our talented ENT physicians, is one of the most experienced thyroid surgeons in the U.S. He has extensive expertise in traditional and minimally invasive thyroid treatment methods and now offers thyroid radiofrequency ablation (RFA).
Traditional treatment methods
Traditionally, thyroid surgery or radioactive iodine would have been the only treatment options for problematic thyroid nodules. While either is generally safe, there are certainly drawbacks to both.
Thyroid surgery, while a very safe procedure, is still surgery. It involves a trip to the hospital or surgery center, general anesthesia, post-surgery pain and a period of recovery.
Additionally, there are risks specific to thyroid surgery. This can include bleeding, scarring, hypothyroidism, possible damage to the vocal cord nerve and calcium deficiency. Cosmetically, thyroid surgery patients often end up trading a lump for a visible scar.
Radioactive iodine therapy
Radioactive iodine therapy also has its challenges. It’s only useful for a rare group of thyroid conditions. Most nodules can’t be treated with radioactive iodine.
What’s more, special precautions must be taken to protect others from exposure to the radiation, especially children. If you have children, you may need to arrange childcare for several days after you have treatment.
Additionally, there are short-term side effects such as nausea, swelling and tenderness in the neck area; dry mouth; and a metallic taste that can stay with you for a while. You may need multiple rounds of treatment. Finally, some studies suggest a low but increased risk of other cancers following radiation for thyroid nodules.
Medication required after traditional treatments
After treatment with either radioactive iodine or surgery, using thyroid hormone medication to achieve normal blood levels can be a balancing act. If you have hypothyroidism, you may feel sluggish and tired. In a person with no other health issues, there’s an approximate 25% chance that one would need to take a long-term thyroid hormone supplement after partial thyroid surgery.
In the United States, these methods have been the only options for patients dealing with thyroid nodules—until now.
An easier option
A common practice in other countries, radiofrequency ablation (RFA) is now available in the United States. Developed more than 15 years ago, this non-surgical alternative shrinks the nodules—usually without compromising thyroid function. It also helps avoid the long recovery times of thyroid surgery.
What is thyroid radiofrequency ablation?
Thyroid RFA is a minimally invasive medical procedure. During the procedure, dysfunctional tissue is ablated (gradually removed) using heat generated from alternating current, passed from the generator to the tissue via an electrode.
Performed under local anesthesia, radiofrequency ablation is relatively painless and doesn’t require general anesthesia. Doctors use guided ultrasound to insert a probe into the thyroid nodule. Through selective heating of the probe tip, the nodule is cauterized. The cauterized tissue is then broken down by the body over the course of months.
Advantages of thyroid RFA
Compared to thyroid surgery, the primary advantages of radiofrequency ablation are:
- Increased likelihood of preservation of thyroid function (dramatically lowers risk of needing thyroid hormone supplement)
- NO scarring
- Potential for fewer complications
- Shorter recovery time, with a quick return to normal activities
The entire procedure takes between 15 minutes to one hour. Because it’s minimally invasive and doesn’t require general anesthesia, you avoid the external scarring of traditional thyroid surgery, as well as the risks of general anesthesia. Radiofrequency ablation may also minimize the risk of permanent damage to the vocal cord nerve or to the parathyroid glands.
One of the most meaningful long-term advantages is that you may not need to take lifelong thyroid medication. The treatment preserves healthy thyroid tissue. This allows the thyroid to continue functioning normally—without ongoing medication.
Radiofrequency ablation is highly effective for benign thyroid nodules. Depending on the type (solid vs. fluid-filled vs. a combination of the two), nodules shrink anywhere between 60-90% after one year, with approximately 80% shrinkage on average.
How it works
With thyroid RFA, a generator creates an electric circuit. The electrode is designed to optimally deliver energy to the area being treated.
During the procedure, the doctor places the tip of the probe into the thyroid nodule. The generator creates a high frequency wave and sends it directly to the end of the probe. Your doctor can then adjust the area being treated as needed to ensure that you achieve the desired results.
You’ll likely hear background noise and mild “popping” sounds throughout the procedure. These sounds are normal and signify an appropriate response is taking place.
When the procedure is complete, a small bandage will be placed on the treatment site. Your neck may be cooled with ice packs.
The procedure is so gentle that most people have little to no discomfort. This is because the thyroid nodule itself is not sensitive to pain.
Other than the initial injection of numbing medication, the only remaining sensation is generally pressure. Intermittent sensations of discomfort thereafter can be treated with additional doses of pain medication or adjustment of the probe tip.
Radiofrequency ablation doesn’t cause any scarring to the external neck. In many cases, one small puncture of the skin is sufficient to treat the entire thyroid gland.
What happens after the procedure
In the weeks following thyroid RFA, the cells of the treated thyroid nodule are removed by the body's immune system. Most patients notice the nodule has already become smaller in just two to three weeks, with solid nodules taking longer than cystic nodules.
Part or all of targeted thyroid nodules may be permanently destroyed during the procedure. Immune cells of the body then break down the affected areas, which shrinks the nodules. The percent reduction depends on the original size and nature of the nodules, with around 40–60% reduction after three months and about 60–90% reduction after one year.
Is it covered by insurance?
Although this procedure is FDA-cleared for soft tissue, there’s currently no insurance reimbursement. However, as a patient, you have the right to submit to insurance for reimbursement after the procedure has been completed.
Even if the procedure isn’t covered by your insurance plan, you may still save money overall compared to other treatment options. This is especially true if you have a high-deductible health plan.
Thyroid surgery, for instance, involves hospital or surgery center costs, which can be significant. Also, both surgery and radioactive iodine treatment likely require lifetime prescription drug costs.
Schedule an evaluation
To see if thyroid RFA is an option for you, schedule an appointment with Dr. Simon Wright. He’ll evaluate your thyroid symptoms, fully explain your treatment options and answer any questions you have.
Dr. Wright treats patients from all across the United States and around the world. If you live outside of the Des Moines, Iowa, area, you can inquire about this by talking with Dr. Wright’s nurse, Antonio (firstname.lastname@example.org). Please provide a brief description of your thyroid condition, and we can screen your suitability for thyroid RFA.