At a glance
- Anaesthetic
- Local anaesthetic; you stay awake
- Hospital stay
- Usually home the same day
- Where
- St George’s Hospital, Strowan
Typical for most people. Your consultant will tell you what to expect in your case.
On this page
Who it may help
RFA may be an option if a confirmed benign nodule causes pressure, swallowing discomfort or a neck lump that concerns you, and you would prefer a less invasive alternative to surgery. Suitability depends on its size, position and ultrasound appearance, your symptoms and your overall health.
Before treatment, we review your ultrasound, thyroid blood tests and biopsy results. Benign biopsy confirmation is essential; two benign needle biopsy results are usually needed, although selected nodules may require only one. A suspicious or uncertain result needs further assessment before treatment. This information focuses on benign nodules; treatment of thyroid cancer requires a separate specialist discussion.
Selected nodules that produce excess thyroid hormone may also be considered for RFA. An endocrinology assessment helps compare this with medicines, radioactive iodine and surgery. RFA may not fully correct an overactive thyroid, particularly with a larger nodule.
What are thyroid nodules?
The thyroid is a small, butterfly-shaped gland at the front of your neck. It makes hormones that help control the body’s metabolism. A thyroid nodule is a lump within the gland. Most nodules are benign and many need only monitoring. Some grow large enough to cause neck fullness, discomfort or difficulty swallowing. Others produce too much thyroid hormone.
What is radiofrequency ablation?
RFA uses controlled heat to treat the nodule through a thin needle-like electrode. Ultrasound lets the doctor see the nodule and guide the electrode throughout treatment. Over the following months, the treated tissue gradually shrinks. The aim is to improve symptoms or the appearance of the neck while preserving as much healthy thyroid tissue as possible. The nodule is not surgically removed.
Other treatment options
Monitoring may be appropriate when a benign nodule causes little or no trouble. Surgery can remove the nodule or part of the thyroid and may be more suitable for some large or complex nodules. A fluid-filled cyst may respond to drainage or ethanol ablation, which uses a small amount of alcohol to treat the cyst. For an overactive nodule, radioactive iodine or surgery may be preferred. We will discuss the options that fit your diagnosis and priorities.
Before treatment
Bring a list of your medicines and supplements. Tell the team about blood-thinning medicines, allergies, bleeding problems, previous neck surgery or voice changes, pregnancy and any implanted electrical device such as a pacemaker. These may affect your treatment plan.
You will receive individual instructions about eating, drinking, medicines and transport. Do not stop prescribed medicines unless your treating team asks you to. Ask whether you will need someone to take you home. At your consultation, you can discuss your questions, the expected benefit and the risks before deciding whether to proceed.
During treatment
You lie on your back with your neck supported. The doctor checks the nodule with ultrasound, cleans the skin and uses local anaesthetic to numb the treatment area. You will usually remain awake so you can speak to the team and report any discomfort.
A fine electrode passes through the skin into the nodule. The doctor treats it in small areas, moving the electrode under continuous ultrasound guidance and taking care around nearby structures. You may feel pressure or warmth. Tell the team straight away if you feel pain or notice a voice change so treatment can be adjusted. After the electrode is removed, a small dressing covers the puncture site.
Recovery
You are monitored after treatment and can usually go home the same day once the team is satisfied that you are recovering well. Mild neck tenderness, swelling or bruising can occur. The team will advise which pain relief is suitable for you.
Follow your discharge instructions about the dressing, driving, exercise and returning to work. Recovery depends on your treatment and the activities you do. Improvement develops gradually as the nodule shrinks; it will not disappear immediately.
Benefits and limitations
RFA can reduce pressure symptoms and make a visible lump less noticeable, with a small skin puncture and usually a shorter recovery than surgery. Thyroid function is often preserved, although this cannot be guaranteed.
Some nodules shrink less than expected, leave a residual lump or grow again. A larger nodule may need more than one treatment. Repeat ablation or surgery may be needed if symptoms persist or return.
Possible risks
Most side effects are mild, but complications can occur. These include bleeding or a collection of blood in the neck, infection, a skin burn, and pain or swelling. Heat can affect the nerve controlling the vocal cord, causing a voice change that is usually temporary but can be permanent.
Rarely, nearby structures such as the windpipe or swallowing tube can be injured. The treated nodule can occasionally split or rupture later, causing new pain and swelling. Thyroid hormone levels can change, and some people may need thyroid medicine. Your doctor will explain the risks relevant to your nodule.
Follow-up
Ultrasound follow-up checks how much the nodule has shrunk and whether it is regrowing. Your symptoms and thyroid blood tests may also be reviewed. The timing is tailored to your treatment, and longer-term monitoring remains important even when you feel well. Contact your team if the lump grows again or symptoms return.
When to seek help
Call 111 or attend an emergency department for difficulty breathing, rapidly increasing neck swelling, or severe difficulty swallowing.
Seek urgent medical advice for a new or worsening voice change, fever, increasing redness or swelling, or pain that is not controlled by the advised pain relief. Use the contact details on your discharge instructions. New neck pain or swelling several weeks after treatment also needs assessment.