Not every thyroid nodule needs surgery. For benign nodules that cause complaints, one modern option is radiofrequency ablation (RFA) – a way to shrink the nodule through a needle, without an incision.
Why do we try to avoid surgery whenever possible?
Only a small share of thyroid nodules require surgery. If a nodule is not large enough to cause complaints and examinations show no suspicion of cancer, there is no need to operate on it.
Surgical treatment has its own complications and risks: an operation can leave a cosmetic defect on the neck, and the vocal nerves and parathyroid glands can be damaged during surgery. That is why, in the modern approach, surgery is chosen only for certain groups of patients.
Besides changing the appearance of the neck, large nodules can cause shortness of breath, difficulty swallowing and a feeling of pressure in the throat.
A true nodule – one filled with cells – does not shrink on its own: it either stays the same size or grows. If such a nodule causes complaints, a treatment method to reduce it has to be chosen.
What is RFA?
Radiofrequency ablation is a minimally invasive procedure. Under ultrasound guidance, a thin electrode needle is inserted into the nodule, and radiofrequency energy heats and destroys the nodule tissue from the inside. The healthy tissue of the gland is left untouched.
The body gradually absorbs the destroyed tissue, and the nodule slowly shrinks over the following months. So the result is not immediate – it becomes visible on follow-up ultrasounds.
Who is RFA suitable for?
Nodules suspicious for cancer are not suitable for RFA – they require a different treatment approach. That is why the nature of the nodule must be confirmed by biopsy before any intervention. A fine-needle procedure never spreads a nodule and does not cause cancer.
The decision is always made by the doctor after an examination. In general, RFA is considered in the following cases:
- the nodule has been confirmed benign by biopsy (FNA);
- the nodule causes difficulty swallowing or breathing, a feeling of pressure, or a visible cosmetic problem;
- the patient does not want surgery, or surgery is risky for them;
- in some cases – nodules that produce excess hormone (autonomous nodules).
How is the procedure performed?
RFA is performed on an outpatient basis. After the procedure there may be brief, mild pain or discomfort in the neck. The result depends on the size and structure of the nodule – sometimes a repeat session may be needed. The main steps:
- Preparation: ultrasound, hormone tests and the biopsy result are reviewed.
- Local anaesthetic is applied to the neck – no general anaesthesia is needed.
- Under ultrasound guidance, the electrode is inserted into the nodule and the nodule is ablated section by section.
- After a short observation, the patient usually goes home the same day.
- Over the following months, the shrinking of the nodule is monitored with follow-up ultrasounds.
What are the advantages?
- no incision or stitches, no scar on the neck;
- no general anaesthesia;
- the healthy part of the gland is preserved, so hormone function is usually maintained;
- a quick return to daily life.
Remember: not every nodule is a reason for surgery.
Dr. Samir Shukurov
Fluid-filled cystic nodules are mostly benign. Cystic nodules larger than 30 mm that cause discomfort can be drained with a very fine needle – this is also a separate, surgery-free procedure that takes a few minutes.
If your nodule is causing complaints, the first step is a proper examination: ultrasound, hormone tests and, when needed, a biopsy. Only then is the most suitable path for you – monitoring, RFA or another treatment – chosen together.
This article is for general information only and does not replace a medical examination.