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Thyroid Radiofrequency Ablation

Reducing the size of benign thyroid nodules without surgery

About thyroid radiofrequency ablation (RFA)

By Dr Simon Morley MA BM BCh MRCP FRCR
Consultant head and neck radiologist

  • Thyroid radiofrequency ablation (RFA) - is a treatment for reducing the size of benign thyroid nodules if they are symptomatic (pressure feeling in the neck) or causing a visible neck swelling.  
  • Is the procedure approved in the UK? Yes. The evidence for this treatment has been assessed by NICE and it has been deemed to be effective. A summary of their guidance can be found here
  • My surgeon says this is an experimental treatment. Is that true? Surgeons have an obvious vested interest in performing surgery! This is not an experimental treatment. It has been validated and tested over many years in large series of patients and is now an estabished treatment performed in many countries around the world and also in the NHS. 
  • How does it work? - Thyroid radiofrequency ablation is performed under local anaesthetic (where the skin is numb but the patient is awake) using a special needle which is passed into the thyroid nodule under ultrasound guidance. The tip of the needle heats up and this heating of the needle heats the adjacent thyroid tissue. This causes the nodule to subsequently shrink down over time. The ablation changes during the treatment can be seen in real time by the doctor delivering the treatment using the ultrasound machine. The doctor can move the needle sequentially through the thyroid nodule until it is all treated.   
  • Is it effective? - The evidence for the effectiveness of RFA is well established in large published series mainly from South Korea where the technique was developed. The maximum benefit of the treatment is achieved 6-12 months following treatment. The end result of the treatment depends on the amount of liquid in the thyroid nodule (how cystic the nodule is) and  how large it is. In general, RFA can reduced the volume of a nodule by 35-60 % at 1 month following treatment and 60-90% at 6-12 months. 
  • How long does it take? The treatment itself takes betwee 20-40 minutes depending on the size and location of the thyroid nodule. It takes a little while to set up all the equipment to deliver the treatment so overall the treatment may take up to 1 hour. 
  • Is it painful? The treatment is delivered following injection of local anaesthetic into the skin and the tissues around the thyroid. This numbs the area to reduce any discomfort. The local anaesthetic is injected using a tiny needle and is not painful. During the treatment some patients experience a heat sensation in the neck, mild chest or jaw ache. If this happens the treatment can be stopped until the feeling goes away and more local anaesthetic given if needed.
  • What does it feel like having the treatment? Patient experience pushing and pressure on the neck during the treatment. When the treatment is being delivered the ablation process causes the thyroid tissue to "pop". This can be both felt and heard by the patient. It indicates good ablation and is an indicator that the treatment is going well. 
  • I'm really needle phobic. Can you help me with this? Yes. I use the invisible needle to deliver the initial local anaesthetic to the skin as this is where most of the sensation is felt. Once this is numb you should not feel the other needles. 
  • How long after the procedure can I go home? Patients are able to go home 20-30 minutes after the treatment. Sometimes simple analgesia with paracetamol is needed as the neck can be a little more swollen and tender for a few days following the treatment. Many patients are able to go back to work the next day after having had the treatment. 
  • Will I have a scar on my neck? No. The treatment is delivered using a thin needle. You may have a small needle site on your neck for a couple of days after the treatment but this very soon heals and it will not leave any visible scarring.
  • My nodule is benign. Can I have this treatment? If you have a visible swelling in you neck and or have symptoms which are attributable to your nodule then you may be suitable for this treatment. Please contact us to arrange a consultation so we can discuss with you further and assess your suitability. 
  • My nodule is Thy 3, 4 or 5 on cytology. Can I have this treatment? Thyroid RFA is approved in the UK for benign (Thy2) thyroid nodules. Surgery is the current standard of care for Thy3, 4 and 5 nodules but over time research is being performed regarding using RFA on these nodules and at some point it may become routine. In the circumstance where a thyroid MDT agrees that RFA for a Thy 3, 4 or 5 nodule is appropriate then it could potentially be performed. 
  • Will the treatment affect my thyroid function? The results from the large series of patients treated with RFA suggest that the rate of hypothyroidism following treatment is very low (<1%)
  • Will the nodule dissappear completely? Unless the nodule is almost entirely made of fluid it will not dissapear completely. There will always be some residual nodule although the tissue within it may not be alive and the aim of the treatment is for the nodule to not be visible as a swelling in your neck or giving you symptoms.  
  • I have multiple nodules. Can you treat more than one at the same time? Yes. It is possible to treat more than one nodule on the same side of the thyroid during the same treatment and we frequently do this. 
  • I have nodules on both sides of my thyroid. Can you do both sides at the same time? In general we do not treat nodules on different sides of the thyroid at the same treatment as there is some initial swelling associated with the procedure and it is safer to perform one side at a time. 
  • I have a toxic nodule. Can RFA treat this? Yes. Thyroid radiofrequency ablation (RFA) is an exciting treatment for toxic nodules and can result in a a normalisation of thyroid function with one treatment, avoiding the need for surgery, radioiodine and long term thyroxine medication. It works best in patients with a solitary toxic nodule (rather than a toxic multinodular thyroid) and is unsuitable for patients with Graves' disease. Dr Morley has had some excellent results with this treatment in patients with toxic nodules. 
  • What are the main potential serious complications? Thyroid radiofrequncy ablation performed by experienced head and neck radiologists is a safe procedure. The published rates of major complications (mainly in research from Korea) are low and are summarised here. The rate of major complaications in these series was 1.4% including 1% voice change (all resolving after 3 months), nodule rupture (0.14%), abscess (infection in the neck) (0.07%), hypothyroidism (0.07%) and injury to the brachialplexus (0.07%). Minor complications include brusing around the thyroid (haematoma)(1%),  vomiting, (0.62%) and skin burn (0.27%).  Dr Morley has not had any serious complications in the patients he has treated. 
  • My nodule has reduced in size with RFA. I'm pleased with the result. Can I repeat it to reduce the size some more. Yes. Thyroid RFA can be repeated on the same nodule if needed or at different sites. Patients with larger nodules (>20cm3) at baseline are more likely to need additional treatments to achieve the desired result. 
  • What is the risk of the nodule regrowing? If the thyroid ablation is incomplete there is a small risk of nodule regrowth. The aim of the treatment is to fully ablate the thyroid nodular tissue to prevent regrowth. 
  • What is the nodule made of after the treatment? The thyroid RF ablation effectively kills the nodular thyroid tissue so it shrinks down and remains as tissue that is dead and remains within the thyroid.
  • What technique do you use to deliver the abation? I use the "moving shot technique" as it is the safes way to perform thyroid RFA. This technique minimizes the risk of damage to the recurrent laryngeal nerve and the risk of hoarse voice. 
  • What skills do you need to perform RFA? The key skills needed are a good knowledge of the anatomy of the thyroid region on ultrasound but specifically extensive experience of visualising a needle in the thyroid. This means having perfomed thousands of ultrasound guided FNAs and biopsies.

Thyroid ultrasound

Dr Simon Morley MA BMBCh MRCP FRCR
Consultant head and neck radiologist
GMC: 4331067

Dr Simon Morley was the first doctor in the UK to perform thyroid radiofrequency ablation and has the largest UK experience of delivering this treatment. He is an experienced head and neck radiologist based at University College London Hospitals NHS Trust where he leads the thyroid RFA service. Dr Morley has performed over 35000 neck ultrasounds and thousands of neck and thyroid ultrasound guided biopsies. He is therefore very experienced at placing and localising needles in the neck with ultrasound which is they key skill neeeded for delivering this treatment. He has performed over 50 thyroid radiofrequency ablations in the thyroid without complication and is the most experienced thyroid RFA operator in the UK. 

Dr Morley has trained other consultants in how to perform thyroid RFA and has lectured at international conferences on the technique:

Barts thyroid symposium 2017
British society of head and neck imaging 2017
CIRSE Denmark 2017 with RF Medical
European society of head and neck radiology 2018

Thyroid RFA assessment and treatment

Dr Morley delivers thyroid radiofrequuency ablation at 9 Harley Street, London. If you would like to be considered for thyroid radiofrequency ablation please contact us to arrange a consultation appointment.

1. Dr Morley will see you and perform an ultrasound of your neck. He will assess your suitability for the treatment and advise you of the likely volume reduction you can expect from the treatment. He will outline the risks of the procedure so that you can make an informed choice as to whether you wish to proceed. The cost of this initial consultation and scan is £329. Please note the RFA treatment is not performed at this initial consultation. 

2. All patients who wish to have thyroid RFA will need to have at least one (possibly more if your nodule is classified U3 on ultrasound) fine needle aspiration (for cytology) before RFA can be performed. There is an additional cost associated with having a ultrasound guided fine needle aspiration. 

3. If a patent would like to proceed with the treatment it is arranged for a mutually convenient date.

4. The cost of the radiofrequency ablation for self paying patients is £2650.

Insured patients

Dr Morley is recognised by all the major medical insurance companies (BUPA, BUPA International, AXA PPP, (Aviva), WPA, Standard Life, Pruhealth Cigna, Saga, etc.) Patients are strongly advised to contact their Insurance Company prior to their appointment to confirm their cover and to obtain a preauthorisation number which will ease the reimbursement process.

The procedure code for thyroid RFA is B1280. 

Feedback

"The team there was fantastic, and the procedure was not the terrifying experience as I was expecting. I was scared up to the point where the first ablation happened and then I instantly relaxed because it wasn’t painful. There was very little pain in my case. I think they inject the minimum necessary amount of local aesthetic because at some point it became painful so I told them and they immediately injected more so the pain went away. I could feel at times the probe moving in my nodule, some jaw pressure and the popping of the tissue under the probe’s heat I suppose, but even if it sounds weird I actually liked that sensation (like bubble wrap being popped next to your skin)."

Clinic address

9 Harley Street
London
W1G 9QY

Middlemead Medical Ltd trading as thyroidradiofrequencyablation.co.uk registered in England no:11279604
Registered Office: 20 Coxon Street, Spondon, Derby DE21 7JG