Thyroid radiofrequency ablation is a clinically proven treatment for benign thyroid nodules. Every medical procedure involves certain risks.
However, RFA is non-invasive and offers an incredibly low frequency of risk and complications. In fact, some studies have been performed which found 0 major complications across several patients who underwent RFA for their thyroid nodules.
In this article, we’ll explore what radiofrequency ablation is as well as the benefits and potential complications associated with this therapy.
In order to reduce complications and risks, physicians should utilize the moving shot technique along with the proper equipment.
The moving shot technique involves placing the electrode probe inside the patient’s thyroid nodule. From here, slow continuous motion from the anterior to posterior positions of the thyroid nodule is suggested.
Continuously reposition the electrode probe, plane after plane, to ablate the necessary tissue. Be sure to keep visualization of the entire thyroid nodule and surrounding critical structures. This can help avoid potential complications or damage to non-ablated tissue and surrounding critical structures.
To use the moving shot technique properly, an imaging system like the E-Cube i7 along with an RF ablation machine like the Mygen V-1000 is recommended.
That’s because the most important aspect of this therapy is to maintain vision of the probe as it pertains to the nodule and surrounding areas — as well as avoid over ablating tissue.
Additionally, a grounding pad, pump, local anesthetic, and even needle guide can aid in the efficacy and safety of this procedure.
A study by the Chinese Medical Journal in 2017 looked at 32 studies and 3,409 patients who underwent radiofrequency ablation for benign thyroid nodules. Ultimately their conclusion was that RFA is safe and well tolerated for BTNs.
However, out of the thousands of patients, there were some rare and relatively minor complications:
Immediately after ablation, patients can experience hoarseness. Most patients recover fully within three months without any need for special treatment. Doctors can prescribe prednisone for reducing the recovery period.
Surgeons should understand neck anatomy and assess relevant nerves such as the vagus nerve and laryngeal nerve before RFA. Moving shot technique can help avoid this type of nerve injury.
There was one case out of the over 3,000 patients studied in which a patient experienced brachial plexus nerve complication post RFA. However, they gradually recovered within two months.
The issue was caused due to the electrode penetrating outside of the thyroid gland. Proper imaging technology should be used during the RFA procedure to prevent this.
Ocular discomfort and redness of the conjunctiva have been reported after RFA. The patient was able to improve at around six months without further treatment. However, the syndrome did persist.
In this patient, the RFA was close to the middle cervical sympathetic ganglion (mCSG). The location of the mCS, is typically near the lower portion of the thyroid gland, lateral to the common carotid artery. Caution should be exercised and imaging equipment should be utilized to properly identify this and other surrounding structures.
Fourteen cases of nodule rupture were found post-RFA. This involves intrathyroidal lesions toward extrathyroidal lesions and a leak of fluid. Patients reported symptoms like neck swelling and pain between nine days and five months post-RFA.
Seven patients ultimately had their lesions disappear with zero invasive procedures or medication. Two patients were given antibiotics which gradually regressed the lesions. Three patients ultimately had an incision and drainage performed.
Risk factors suggested are the following: Lesions close to the anterior thyroid capsule, mixed and large component nodules which could require higher RF power, longer ablation and higher RFA power. Using an algorithmic ablation machine such as the Mygen V-1000 could be helpful in maintaining safe ablation levels and avoiding such nodules, although rare in the first place.
Only two cases of needle track seeding were found in this study after RFA for BTNs. Proper follow-up should be scheduled to monitor nodule volume. For at least five years, a yearly follow-up should be the minimum standard to avoid potentially malignant cells forming and growing.
Twelve patients experienced vomiting and nausea after radiofrequency ablation. However, no patients reported these symptoms during the ablation itself.
The most probable cause is the neck extension. This can create an imbalance in cerebral blood flow. Vagus nerve stimulation may also be a cause. Patients with a previous history of nausea and vomiting may also be at higher risk. Antiemetics can improve these symptoms in under two days.
These complications have been reported as possible side effects. The likely cause is a large thyroid nodule and skin bulging. Typically these symptoms can disappear after one to two weeks. A mild compression for five to ten minutes on the neck and frequent application of an ice bag could prevent these symptoms.
Research The Korean Society of Thyroid Radiology looked at 1,459 patients who underwent thyroid RF ablation.
48 complications were observed. In other words, 3.3% of the patients had complications. 20 major complications and 28 minor complications were observed.
The major complications were the following: Tumor rupture (3). Brachial plexus injury (1). Voice changes (15). Hyperthyroidism (1).
The minor complications were the following: Skin burn (4). Hematoma (15). Vomiting (9).
Every patient recovered spontaneously, except for one patient. This patient had permanent hypothyroidism and underwent surgery.
Using RFA, you can help your patients enjoy reduced compressive symptoms and a life free of hyperthyroidism. However, as with any medical therapy, you should adhere to the proven best practices.
Ensure that you equip your office with the best imaging and radio frequency ablation equipment possible. Contact RGS Healthcare today to enjoy state of the art machinery that enables you to treat patients quickly and effectively.
Ultimately, you can avoid surgical procedures while enhancing health outcomes for your thyroid nodule patients.