Therapeutic Efficacy In Treating Cystic And Predominant Cystic Thyroid Nodules
Thyroid nodules included in this study were further divided into CYS and M-CYS ones based on the cystic component. There were 18 and 9 CYS thyroid nodules in EA and MWA groups, and 12 and 22 M-CYS thyroid nodules in EA and MWA groups, respectively. The median VRR of CYS thyroid nodules during the follow-up period was higher than that of M-CYS ones. There was no statistically significant difference in VRR between the two treatment modalities during follow-up based on cystic component proportions .
What Is Radiofrequency Ablation
Radiofrequency ablation is a technique using an electrode with high frequency alternating current to cause thermal injury in soft tissue leading to cell death and shrinking of the affected part.
RFA technology has been widely used for a range of conditions, including nerve pain, certain types of cancer, uterine fibroids, and some vascular conditions. This technology was approved by the U.S. Food and Drug Administration to be used for benign thyroid nodules in 2018.
How Much Does It Cost The Radiofrequency Ablation Therapy
The price of the radiofrequency ablation will be influenced by a few factors such as the place where you are living and the clinic you choose. According to our online research, the costs of this procedure are almost never covered by health insurance policies. So, you will have to support all of the costs from your pocket and pay all the sum at once or set up a payment plan with the clinic. You should plan on spending anywhere between $3,000 and more than $5,900 for this procedure, with the effects lasting around two years.
The MDSave national average cost is $3,351, while the estimated national average cost is $5,920, according to the MDSave website.
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What Are The Side Effects Of Radiofrequency Ablation
You may experience the following effects after RFA:
Numbness in the feet: If you have numbness in the legs, only walk with assistance. This should only take a few hours and is due to local anesthesia given during the procedure.
Slight discomfort in the back: This can occur when the local anesthetic disappears and usually lasts two to three days. Apply ice to the area on the day of the procedure and moist heat the day after the procedure, if the discomfort persists. You can also use regular pain medications.
The main side effect of RFA is some discomfort, including swelling and bruising at the treatment site, but this usually goes away after a few days.
What Are The Risks Of Radiofrequency Ablation
Complications of RFA are similar to those of surgery but occur at a lower rate. Risks include vocal cord paralysis, bleeding, voice hoarseness, infection, and damage to the surrounding structures in the neck.
One potential drawback is that RFA may not be covered by insurance because it is so new. Radiofrequency ablation currently carries out of pocket costs, and physicians are working at the national level to encourage insurers to cover the procedure in the future. If you need or want this procedure, UT Southwestern patient services can help you navigate resource options.
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Rfa For Follicular Thyroid Neoplasm
RFA treatment for follicular neoplasm is more controversial than PTC since surgical resection is required to exclude the presence of vascular or capsular invasion to definitively diagnose whether the nodules is a follicular adenoma compared with a carcinoma. However, a recent 5-year study including 10 patients with follicular neoplasm < 2 cm in size found on thyroid biopsy reported that RFA is safe and effective in the short-term for such cases. Ha et al. demonstrate a significant reduction in the mean volume of lesions, with eight ablated lesions disappearing completely after single treatment on follow-up and no recurrences noted . Further large-scale trials are required to confirm effective oncological control, as it is unclear if sonographically invisible carcinomas still have metastatic potential.
Thyroid Radiofrequency Ablation For Benign Thyroid Nodules
Thyroid nodules, even when benign , can grow visibly large and cause swallowing or breathing difficulties, persistent cough, and hoarseness. Radiofrequency Ablation is a non-surgical treatment option that can reduce the size of thyroid nodules and restore thyroid function. RFA is a minimally-invasive technique performed by an endocrine surgeon guided by ultrasound imaging. The physician delivers targeted radio waves that disrupts the nodules cells, causing them to shrink as the body absorbs the ablated tissue.
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Frequently Asked Questions Regarding Thyroid Radiofrequency Ablation
Thyroid RFA is a minimally invasive procedure that uses ultrasound for guidance and a special electrode that transmits radio frequency waves into the thyroid nodule that generates heat and in turn reduces the size of the nodule. This cutting-edge RFA technology is used to treat thyroid nodules that are non-cancerous.
Large benign nodules that negatively affect your voice and/or breathing are the best candidates to achieve successful results by this treatment. Additionally, good candidates for the ablated thyroid procedure are individuals whose nodules are visible and causing pain in the neck region.
At this time, RFA is limited to nodules which are benign however, the plan is that RFA may also become an option for individuals who have small thyroid tumors that are cancerous.
Benign Toxic autonomous thyroid nodule is the other subgroup of patients who could significantly benefit from Thyroid RFA instead of the conventional nuclear medicine, which can lead to permanent hypothyroidism.
Pregnant women should not undergo RFA treatment due to the electrical currents. For the same reason, patients with cardiac arrhythmia should stay away from this type of treatment.
This procedure is referred to as minimally invasive and non-surgical. To be classified as non-surgical, the procedure does not involve cutting and/or the removal of bodily organs and/or any tissue.
Not only is RFA effective on thyroid nodules, but it is also a safe and effective treatment for reoccurring cysts.
If The Price Is Right: Cost
- Eric J. KuoCorrespondenceReprint requests: Eric J. Kuo, MD, Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, 161 Fort Washington Avenue, HIP-8, New York, New York 10032.
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Therapeutic Efficacy In Treating Small And Medium Thyroid Nodules
In group A, the median VRRs at 3 and 12 months after ablation were significantly higher in EA group than in MWA group , while no significant difference was detected between the two treatment modalities during follow-up in group B . After MWA, the median VRR was higher in group B than in group A, but the difference was only statistically significant at 12 months . Moreover, after EA, no significant difference was observed in VRR between group A and group B during the follow-up .
What Can I Expect After The Procedure
For benign nodules, when the primary goal is to reduce the size of the nodule, patients usually notice a reduction in size approximately one month after the procedure. This shrinkage will continue with time until the nodule is significantly smaller. However, we do not expect 100% resolution of the nodule. The goal is to treat these nodules in a single RFA session, however very large nodules, or nodules not well controlled with one treatment may require additional RFA treatments to achieve optimal size reduction.
For malignant nodules or lymph nodes, your multidisciplinary treatment team will monitor the tumor over time, to ensure the cancerous tissue has been fully treated.
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Radiofrequency Ablation Therapy: Frequently Asked Questions
- What is Thyroid Ablation?
Radiofrequency ablation of thyroid nodules has been around for about 15 years now. It has been performed in several European countries for several years and is now available in the United States. The term “radiofrequency ablation” refers to processed in which the tissue is destroyed by heat. During thermal ablation, a probe is introduced into the nodule under the guidance of ultrasound. The nodes are destroyed by selectively heating the probe tip. Since there are no nerve fibers in the nodules, the procedure can be performed under local anesthesia. It is relatively painless. Once the tissue is broken down, it shrinks between 60-90% the first year.
- What are the benefits of thyroid ablation?
There are many advantages of this procedure:
- This is a minimally invasive procedure with little to no scarring.
- The procedure lasts 15 – 60 minutes.
- Since healthy tissue is not destroyed during this procedure, the use of thyroid medications is not expected afterwards.
- The procedure is highly effective. The reduction in size for a nodule is typically between 60-90% after one year.
- This procedure has a very low complication rate. Damage to the vocal cord nerve or parathyroid corpuscles are not expected.
As with any medical procedure, there are potential complications, although very rare, from having the RFA procedure which could include:
Radiofrequency Ablation Of Thyroid Nodules
Until recently, surgical excision was the only option to remove thyroid nodules. Though surgery is considered safe, it is not without risk to the nerve which controls the vocal cord, or a cosmetically unacceptable incision at the base of the neck. When half of the thyroid gland is removed, approximately 20% of patients will need thyroid supplementation afterwards and unfortunately there is no way to gain back thyroid function after it has been lost.
Radiofrequency ablation is a new technique of shrinkingthyroid nodules without the risks of surgery. The procedure uses a hand-held electrical device in the office and takes about 45 minutes. This technique is supported by strong evidence for treating symptomatic or visible benign thyroid nodules. The data is also strong for treating toxic thyroid nodules and even low risk papillary thyroid carcinomas measuring 1 to 1.5 cm or smaller in size.
The procedure is performed in the office with oral sedative medication and local anesthetic. Over the counter pain medication is all that is needed afterwards for pain control, and there is virtually no downtime from normal activity. Radiofrequency ablation can limit the need for thyroid surgery, which allows patients to keep their thyroid and reduce the risk of needing to take thyroid supplements.
For many patients, thyroid nodule ablation with RFA will eliminate the need for surgery.
For patients travelling to Atlanta for RFA, a local overnight stay after the procedure is recommended.
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Surgery Versus Radiofrequency Ablation For Benign Nodules
For symptomatic benign thyroid nodules, an open thyroidectomy is the standard of care. However, surgery may not always be the best choice, particularly for older patients who are not ideal surgical candidates or for patients who do not wish to risk hypothyroidism, scarring, hoarseness or surgical recovery time especially for benign disease. In a meta-analysis comparing thermal ablation with conventional thyroidectomy, thermal ablation was safer and had significantly lower incidence of hoarseness, hypothyroidism and postoperative pain . After thermal ablation, patients had significantly better postoperative cosmetic outcome and shorter hospitalization time compared with conventional thyroidectomy . However, in terms of symptom improvement, both options were equally favorable, with no statistical difference between thermal ablation and conventional thyroidectomy , thus showing RFA as a promising treatment option .
One of the key benefits of RFA compared with surgery is the reduced chance of causing post-treatment hypothyroidism. Surgery involves removing the gland with the nodule and the normal parenchyma, whereas RFA targets the nodule alone, leaving the normal tissue protected and preserving thyroid function . Whether RFA changes the tissue planes, making it more difficult to resect surgically at a later date remains to be determined.
Thermal Treatment: Currently Available Techniques
Among the currently available TA techniques for benign thyroid nodules, laser thermal ablation , radiofrequency ablation , microwave ablation , and high-intensity focused ultrasound have been tested in clinical practice and will be addressed in the present document. The devices employed by the different technologies are also defined as applicators .
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Ethical Approval And Consent To Participate
The studies involving human participants were conducted according to the ethical guidelines of the Helsinki Declaration and approved by the ethics committee of the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine. Verbal informed consent was obtained from all patients by telephone.
Rfa Has Been Proven To Reduce The Size Of Thyroid Nodules
2019 RFA Published Findings for Thyroid Rate of Nodule Reduction According to Size1
| 6 months | ||
|---|---|---|
| Less than 10 mL in size | 79%* | |
| Greater than 10 and less than 20 mL in size | 59%* | |
| Greater than 20 mL in size | 54.5%* | 65.3% |
*Rate of reduction was calculated with respect to the baseline volume.
The term radiofrequency refers to an alternating electric current oscillating between 200 kHz and 1200 kHz. Application of radiofrequency in a medical setting agitates tissue ions as they attempt to follow the changes in direction of the alternating current, thereby creating frictional heat around the electrode. The heat generated from the emitter affects the immediate tissue, which is only within a few millimeters of the electrode tip. RF has been used as a medical treatment successfully for many parts of the body including the spine, liver, colon, and prostate.
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Where Is It Available
The use of radiofrequency in thyroid nodules has been utilized in Korea since 2002. The Korean and Italian protocols for benign thyroid disease has been studied internationally and are accepted for safe and effective therapies. The tremendous success of this treatment has created demand around the globe, only to be recently approved in the United States by the FDA in late 2018. Currently there are very few providers in the United States who perform this technique. Dr Harding is one of few providers in the southwest who is trained and equipped to offer this innovative office based therapy
Treatment Of Btns And Follow
Conventional US, contrast enhanced ultrasound , US-guided FNAC and RFA were carried out using a ML615 liner transducer , a real-time US system and a bipolar RFA system. The bipolar RFA instrument consists of an RF generator with a frequency of 470 KHz and an maximum power output of 250W, designed technically overcoming the disadvantages of use of grounding pads. The bipolar RFA electrode used in this study was 15.5-gauge and 15-cm long with a conducting part of 20mm in length . For 150-T20, an internally cooled electrode was provided with a peristaltic pump perfusing 0.9% NaCl solution at 30mL/min.
US assessments including gray scale US and color Doppler US were performed for the RFA group patients at 1, 3, 6 and 12 months after treatment and every 6 months thereafter. Thyroid function tests were performed one month after treatment for patients of the two groups, and if any functional anomalies were demonstrated, they needed to be evaluated every month until normalization. For the hypothyroid patient, thyroid function was examined to adjust the optimal dosage of levothyroxine every month thereafter. For the euthyroid patients the tests were reassessed at the 6-month follow-up. Any adverse event that occurred immediately after treatment and during follow-up period was also addressed.
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Ablation Of Thyroid Nodules With Radiofrequency : Questions And Answers
Thyroid nodules are abnormal enlargements, almost always benign in nature, that can occur in the thyroid gland, located on the front of the larynx and trachea. About 95% of nodules are benign in nature, only about 5% are malignant. Among the latter the most frequent are the papillary thyroid microcarcinomas. Dr. Roberto Valcavi, expert in Endocrinology and Interventional Thyroidology, Director of the ETC Clinic of Reggio Emilia, Italy, explains how benign nodules and malignant microcarcinomas can be destroyed with radiofrequency thermal ablation thus avoiding open surgery and the sacrifice of part of the thyroid or of the entire thyroid gland .
INSIGHT
1) What is Radiofrequency Ablation ?
Radiofrequency thermal ablation is an outpatient procedure that is carried out under ultrasound guidance, without the need to make surgical incisions. By means of a needle-electrode overheating nodular tissue, the volume of benign thyroid nodules is reduced by at least 80%. The reduction in volume of the nodule is generally sufficient to make the compressive symptoms disappear and obtain excellent aesthetic results. RFA improves the quality of life . Micropapillary cancers disappear after RFA procedure.
2) When RFA is indicated?
Radiofrequency thermal ablation is indicated for the treatment of solid or partially cystic benign nodules of the thyroid gland. Also in Autonomuously Functioning Thyroid Adenomas RFA obtains good outcomes.
6) Which is post-operative therapy?
What Are The Indications For Rfa Of Thyroid Nodules
The most common indications for thyroid nodule RFA are for the treatment of biopsy-proven benign, solid thyroid nodules which cause pressure or cosmetic problems. Predominately cystic or fluid-filled thyroid nodule are better treated with alcohol ablation.
Other indications include the treatment of autonomously functioning thyroid nodules as an alternative to surgery or radioactive iodine.
In certain circumstances, small primary thyroid or recurrent thyroid cancers, which are not located near critical structures, can be treated with RFA in patients who prefer to avoid surgery or who are not good surgical candidates due to other comorbid medical conditions. Whether RFA is an appropriate treatment is determined on a case-by-case basis by your multidisciplinary team of doctors.
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Radiofrequency For Benign Thyroid Nodulescritical Review Of The Literature
Leonardo Guimaraes Rangel1^, Erivelto Volpi2, Jose Higino Steck3, Leonardo M. Volpi4, Jonathon Russell5, Haris Muhammad6, Ralph P. Tufano5
1 State University of Rio de Janeiro , UNICAMP Universidade Estadual de Campinas , Universidade Santa Casa de São Paulo , Department of Otolaryngology Head and Neck Surgery , Johns Hopkins University School of Medicine , , USA
Contributions: Conception and design: LG Rangel, E Volpi, JH Steck Administrative support: None Provision of study materials or patients: None Collection and assembly of data: LG Rangel, E Volpi, JH Steck, LM Volpi Data analysis and interpretation: LG Rangel, RP Tufano Manuscript writing: All authors Final approval of manuscript: All authors.
^ORCID: 0000-0002-6421-4687.
Correspondence to:
Keywords: Radiofrequency thyroid nodule benign ablation
Received: 24 May 2020 Accepted: 25 February 2021 Published: 30 March 2021.
doi: 10.21037/aot-20-45