Is Thyroid Radiofrequency Ablation (RFA) Right for Me - Part Two - Endocrine Surgery

Hi, I’m Dr. James Wu, endocrine surgeon at UCLA Health. If you’ve been told you have a thyroid nodule, and you’ve been looking into treatment options, you might have come across something called radiofrequency ablation, or RFA. It’s a newer, minimally invasive procedure that’s been getting a lot of attention lately.

One of the most common questions I get is, “Am I eligible for RFA?” So today, I want to walk you through how we decide who’s a good candidate, and just as importantly, who is not.

For more basic information on RFA – what is it and how does it work, please see our other videos and the UCLA endocrine center website.
Now here’s the most important point I want to make up front:

Until now, RFA was not meant to treat thyroid cancer, or any nodule that is suspicious for cancer. That’s really important. Most of the research in this area, and what we know about RFA, involves benign thyroid nodules.

Our policy was to NOT perform RFA for thyroid cancer. After RFA, we have no way of knowing whether all the cancer cells were treated. It is difficult to track the lesion over time, because the RFA procedure changes how the thyroid nodule appears. RFA also creates scarring that makes any future surgery more difficult.

This is currently changing, slowly. Based on latest evidence, RFA may be offered for papillary thyroid cancer that are smaller than 1 cm. We strongly advise against the use of RFA for other types of thyroid cancer, and for any cancer that is bigger than 1 cm.

So if you're wondering whether you're a candidate, the first and most critical requirement is that the nodule must be benign, and we confirm that with a biopsy.

In most cases, we need two separate fine needle aspiration biopsies that both show benign results before we can safely move forward with RFA. That gives us a very high level of confidence that the nodule is non-cancerous.

So let’s say you have a confirmed benign thyroid nodule—what else makes someone a good candidate?

Typically, these nodules fall into one of two categories:

1. Nodules causing compressive symptoms

These are nodules that are physically large—they may not be dangerous, but they can start pressing on your windpipe, esophagus, or the muscles in your neck. That can lead to symptoms like:

A feeling of tightness or fullness in the neck
Trouble swallowing
Hoarseness or voice changes
Neck discomfort when lying down
Or just being very self-conscious about the appearance of the neck

If you’ve got a benign nodule that’s causing those kinds of symptoms, RFA may be a great option to shrink it down—without the need for surgery, general anesthesia, or a scar.

2. Nodules causing cosmetic concerns

Some nodules aren’t causing medical symptoms, but they’re visible and bothering patients cosmetically—especially thinner individuals or those with nodules right near the skin. If the nodule is benign and you’re otherwise healthy, RFA may still be a good fit.

Now let’s talk about who isn’t a good candidate.

In addition to thyroid cancer, there are a few other situations where RFA might not be the right choice.

If the nodule is very small and not causing symptoms, we usually just monitor it.
If the nodule has features on ultrasound that are suspicious—like irregular borders, microcalcifications, or very high vascularity—we need to be more cautious.
If you’ve had only one biopsy, we may ask you to repeat it for confirmation.
And finally, if there are multiple nodules or other thyroid issues going on, sometimes surgery ends up being a better long-term option.

There’s also the question of expectations. RFA is not instant—the nodule shrinks over time, usually over several months. It doesn’t always go away completely, but most patients get a 50–90% volume reduction. That’s often enough to relieve symptoms and avoid surgery.

And the procedure itself is done with local anesthesia, in the office or outpatient setting. You’re awake the whole time. No general anesthesia, no incision, no stitches. Most people go home the same day and are back to normal activities the next day.

At UCLA, we do a careful workup to figure out if you’re a good fit for RFA. That includes:

A high-resolution thyroid ultrasound
A review of your biopsy results
A conversation about your symptoms, goals, and expectations
And sometimes other imaging or lab work, depending on the situation

If everything lines up and you’re a good candidate, we’ll walk you through the procedure, the recovery, and what kind of results to expect.

So to recap:

You may be a good candidate for RFA if you have:

A biopsy-proven benign thyroid nodule
Symptoms like pressure, difficulty swallowing, or visible swelling
A desire to avoid surgery or thyroid hormone replacement

You are not a candidate if:

You have thyroid cancer
Your nodule is suspicious for cancer
You haven’t had a confirmed benign biopsy
Or the nodule is very small and not causing any problems

If you’re not sure where you fall, we’re happy to help figure that out.

Visit us at endocrinesurgery.ucla.edu or call 310-267-7838 to schedule an appointment. We’ll help you understand your options and find the right treatment plan for you.

Thanks for watching. I’m Dr. James Wu—take care, and I’ll see you next time.