Is Thyroid Radiofrequency Ablation RFA Right for Me? Part One

Hi, I’m Dr. Masha Livhits, endocrine surgeon at UCLA Health. I’m going to explain who is eligible for thyroid radiofrequency ablation, or RFA—a newer, less invasive option for treating thyroid nodules.

If you have a thyroid nodule, and especially if it’s benign but large enough to cause discomfort or other symptoms, RFA may be a very good option for you.

Let’s start with the basics: What is RFA, and why would someone consider this procedure?

RFA is a procedure done to shrink a thyroid nodule without surgery. It involves heat energy delivered through a small needle directly into the nodule. We perform RFA under ultrasound guidance in our clinic. There is no scar, general anesthesia, or hospital stay. You go home the same day, and recovery is usually very quick.

But RFA is not for everyone.

The ideal patient for RFA is someone with a large benign thyroid nodule that’s causing compressive symptoms. These symptoms might include:

A visible lump in the neck
A sensation of pressure or tightness
Difficulty swallowing
Discomfort or even shortness of breath in certain positions like when lying down

RFA can reduce the size of a thyroid nodule by about 50-80%. It will not make the nodule disappear completely - only surgery can do that. And it’s important to realize that the nodule will shrink slowly over a few months’ time. But usually, this amount of reduction in the nodule’s size will relieve symptoms and improve the appearance if the nodule was visible, all without needing to remove part of the thyroid gland.

I’d like to point out that not all thyroid nodules need treatment. Many thyroid nodules are small, stable, and not causing any problems. If your nodule is under 2 cm and not growing, we usually just monitor it with periodic ultrasound. RFA is really meant for nodules that are larger and symptomatic. Even though RFA is much less invasive than surgery, it's still a medical procedure, so we only recommend it when we believe it will help the patient.

And that brings me to another key point: Currently, RFA is mainly used for large benign nodules. We require two benign biopsies before offering RFA, because we really don’t want to miss a cancer which would not be adequately treated with RFA.

We want to be absolutely sure that the nodule is not cancer, because RFA is not used to treat large nodules that are malignant or suspicious for cancer. Since RFA for a large nodule cannot destroy all of the tissue, in the case of a malignant nodule it would leave some cancer behind that could grow back or even spread. That’s why we do two separate fine needle aspiration biopsies with benign results. If there’s uncertainty, we may recommend surgery instead.

Sometimes patients ask—“Why not just remove the whole nodule with surgery?”

Surgery is still a great option for many people, especially if we’re concerned about cancer or if there are multiple nodules. But RFA gives us an alternative for people who don’t want surgery, want to avoid a surgical scar, or want to preserve their thyroid function and avoid being on thyroid hormone medication.

So to summarize:

You are likely a good candidate for RFA if you have:

A benign thyroid nodule confirmed by two separate biopsies
A larger nodule that is causing symptoms like pressure, a visible lump, or difficulty swallowing
And you’re looking for a non-surgical option with a quick recovery to shrink the nodule, understanding that the nodule will not completely go away

RFA is not usually recommended if:

The nodule is suspicious for cancer
You haven’t had at least two benign biopsies
Or the nodule is small and not causing any symptoms

Your evaluation should include an ultrasound and consultation to discuss all of the options, including RFA, surgery, or just continued monitoring. The goal is to create a treatment plan that is appropriate for your nodule and your priorities and preferences.

I’m Dr. Masha Livhits, endocrine surgeon at UCLA Health. Thanks for watching this video about thyroid RFA.