thyroid Nodule Ablation

Benign thyroid nodules are present in up to 50% of adults, but rarely cause symptoms. If large, however, thyroid nodules can cause local mass effect symptoms such as swallowing discomfort, sensation of a "lump" in the neck, and cosmetic concern. Traditionally, large benign thyroid nodules were managed surgically with hemi- or total thyroidectomy. Thyroid nodule ablation is a treatment option developed over recent decades that shrinks the thyroid nodule over time to improve the mass effect symptoms, with success rates similar to surgical resection, but faster recovery and low overall complication rates. Ablation treatments are not currently recommended for malignant (cancer) or potentially malignant thyroid nodules, but scientific research is currently underway assessing this.

Thyroid nodule ablation, including radiofrequency ablation (RFA) and ethanol ablation, is a safe and effective first-line treatment for symptomatic, benign thyroid nodules. Since being pioneered by Radiologists in Korea and Italy over the past 20 years, thyroid nodule ablation has become a primary treatment option for benign thyroid nodules, with an excellent safety profile and efficacy (success rates).

Radiofrequency Ablation (RFA) is a type of thermal ablation, which refers to the heating of a nodule causing necrosis (cell death). This is performed by inserting a small needle into the thyroid nodule under ultrasound guidance, and delivering heat energy. The nodule then shrinks over the following 6 to 12 months. Solid or mostly solid thyroid nodules are typically treated with the Radiofrequency Ablation (RFA) technique.

Ethanol Ablation refers to the treatment of a cystic thyroid nodule (cyst) with alcohol (ethanol) liquid. This is performed by first aspirating (removing) the fluid within a thyroid cyst, then injecting a highly concentrated alchohol (ethanol) liquid, which causes the walls of the cyst to become sticky (adhesive) and seal the cavity, shrinking the nodule down. Cystic or mostly cystic thyroid nodules are typically treated with Ethanol Ablation

Effectiveness

• Thyroid nodules are expected to shrink in volume (size) by 50 to 80% over the 6 to 12 months following ablation treatment
• Up to 90% of patients experience improvement in their local mass effect symptoms including swallowing discomfort and sensation of a "lump" following ablation
• There is a small chance (up to 10%) of residual or recurrent nodules that may require further treatment
• The chance of residual or recurrent symptomatic nodules is higher with large nodules, and some nodules will require multiple treatments to achieve the desired outcome

1. A specialist interventional radiologist will first consult and examine you in the outpatient clinic to assess your suitability for ablation. If your thyroid nodules are not suitable for ablation treatments, your Interventional Radiologist (IR) will discuss this with you and arrange referral to another specialist as appropriate.
2. Thyroid nodule ablation procedures are performed as a day-case, with local anaesthetic under ultrasound guidance; there is typically minimal pain or discomfort other than the initial “sting” of local anaesthetic and you will be awake during the procedure
3. Grounding pads will be placed typically on your thighs
4. The small ablation needle (similar in size to a blood test needle) is inserted into the thyroid nodule and the ablation treatment performed over a period of up to 45 minutes. The needle will be frequently repositioned inside the thyroid to ablate each area of the nodule.
5. You will be observed in the hospital for up to 4 hours post-operatively
6. There may be swelling of the nodule for up to 1 week after the procedure, before the nodule then shrinks down over time (6 – 12 months) to a smaller size than pre-treatment
7. There is minimal scarring at the needle insertion site and recovery times are typically shorted than after surgery (thyroidectomy or hemi-thyroidectomy)
8. There is a chance (approximately 20%) that the nodule can regrow. If this is the case, ablation treatment can be repeated, or other options may be considered on discussion with the treating Interventional Radiologist.

The overall risk of significant complications after thyroid nodule ablation (RFA) is low (<3%), but these may include:

• Neck haematoma (bleeding) or nodule rupture; this can usually be managed with compression, or in rare cases may require antibiotics and drainage
• Nerve injury and voice change 

Interventional Radiologists (IRs) are uniquely specialty trained in both the advanced imaging (ultrasound) assessment of thyroid nodules and image-guided "pin-hole" procedures in the thyroid, including FNA biopsy. It was with this unique skillset that thyroid nodule ablation was first invented by Radiologists in Korea and Italy over 20 years ago. Interventional Radiologists (IRs) are extensively experienced in ablation procedures as they undergo comprehensive dedicated training in Radiofrequency Ablation (RFA), Microwave Ablation (MWA) and Ethanol Ablation of tumours throughout the body, including the kidney, liver, lung and thyroid.

Dr Matthew Lukies

Matthew has a keen interest in minimally invasive thyroid procedures, including ablation, and has performed over 1500 thyroid and head & neck ultrasound guided procedures. He was fortunate to spend time training with Prof Jung Hwan Baek (Radiologist) in Seoul, Korea, a true pioneer who has been performing thyroid nodule ablation procedures for over 20 years. Matthew is active in research and future developments in thyroid ablation treatments, as a member of the Asia-Pacific Society of Thyroid Surgery (APTS) and European Group on Minimally-Invasive Thyroid Treatments (MITT). He is passionate about providing minimally invasive treatment options to both public and private patients, and was the first to perform thyroid nodule ablation (RFA) in the public healthcare system in Melbourne, Australia, after advocating for its funding and inclusion as a treatment option for the community. Matthew consults patients weekly regarding thyroid nodules and minimally invasive treatment options.

Matthew is the primary author of the Thyroid Nodule Ablation article on Radiopaedia - the leading global information resource for physicians about radiological imaging and procedures.

https://radiopaedia.org/articles/thyroid-nodule-ablation-1

It is important that you consider all main treatment options for benign thyroid nodules, which includes surgical options. After consultation with our interventional radiologist, your case may be discussed with or you may be referred to consult with a thyroid surgeon if you haven't previously seen one.

If you would like to consult with an Interventional Radiologist about thyroid nodule ablation, please send a referral for consultation, including the following

• Thyroid ultrasound results
• Thyroid fine needle aspirate (FNA) results
• Records of consultations with other doctors and specialists

Public eligible patients can undergo the treatment with no out-of-pocket expense in the public system.