Dr Meyer-Rochow is the first New Zealand clinician to have completed thyroid nodule radiofrequency ablation (RFA) training and able to offer this innovative new treatment option for patients in New Zealand. RFA ablation of thyroid nodules is a non-surgical alternative for the treatment of thyroid nodules which uses heat to cause destruction of the thyroid nodule. However not all thyroid conditions or nodules are suitable for this procedure and the indications for and results of thyroid nodule ablation can often be exaggerated by unregulated internet content.
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What can be treated by thyroid nodule radiofrequency ablation?
Thyroid nodules treated with RFA need confirmation they are benign. This is because the ablation procedure may not completely destroy all of the living tissue within the nodule. Confirmation of a benign nodule will usually require a needle biopsy done on TWO separate occasions unless the ultrasound scan has a high degree of certainty of a benign nodule in which case only one needle biopsy will be required. This procedure is most effective on small to moderate sized nodules ( less than 4-6cm in size). Larger nodules can be treated but are less likely to have an optimal response with initial treatment and have a higher risk of recurrence.
Thyroid papillary microcancers (less than 1cm in size) in a favourable position may also be treated with this RFA ablation. It is not recommended for treatment of larger cancers or other thyroid cancer subtypes.
Functioning (overactive) solitary thyroid nodules may also be treated by RFA as an alternative to radioactive iodine or surgery although if these nodules are over 2cm in size they are less likely to respond to RFA treatment.
Although RFA has been used for ablating parathyroid gland tumours I do not recommend this due to the risk of parathyroid gland rupture potentially resulting in the seeding of multiple parathyroid gland tumours, and the high likelihood of persistence or recurrence of the parathyroid tumour after attempted ablation. Surgical resection for parathyroid gland tumours can often be done as a minimally invasive approach and is a much more effective and definitive procedure for this condition.
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How does radiofrequency ablation work?
Radiofrequency ablation uses heat generated by electricity to destroy thyroid tissue. A needle probe is placed into the nodule under ultrasound guidance and the heat produced at the needle tip results in heat induced injury and destruction of the thyroid nodule tissue. Only a small area at a time is ablated to avoid injury to nearby normal thyroid tissue and to any surrounding structures.
Due to the electrical energy used with this procedure it may not be suitable for patients with cardiac pacemakers or other electronic implants and is not recommended in pregnant patients.
The name of the procedure can sometimes cause confusion - this procedure does not use radioactive (atomic) energy.
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What complications can occur?
In well selected patients the expected complication rate is low (approximately 1-3%). This is similar to the rates of complication seen with surgery.
The potential complications that can occur with thyroid nodule RFA are nodule rupture, bleeding, infection and voice change from recurrent laryngeal nerve injury. Very rare but significant complications that have been reported include skin burns, oesophegeal or tracheal injury, vascular or nerve injury.