Thyroid Radiofrequency Ablation RFA 101: Is it Safe?

Thyroid Radiofrequency Ablation RFA 101: Is it Safe?

Thyroid Radiofrequency Ablation RFA 101: Is it Safe?

Thyroid Radiofrequency Ablation RFA 101: Is it Safe?

My comments on this article and it’s safety recommendations.

For referral evaluation to have RFA in Korea or Italy call Matt at 310-393-8860 or email [email protected]

Asan Medical Center in Seoul Korea with Dr.JH Baek


Roberto Valcavi of Palmer Institute in Italy



Richard Guttler MD,FACE,ECNU


Radiofrequency Ablation of Benign Thyroid Nodules and Recurrent Thyroid Cancers:

Korean J Radiol. 2012 Mar-Apr; 13(2): 117–125.

1.Physicians who perform thyroid RF ablation should understand the broad spectrum of complications and the steps they can take to prevent or minimize complications and sequelae.

2.Reported complications of thyroid RF ablation include pain, hemorrhage, voice change, skin burn, hypothyroidism, hyperthyroidism, infection and nodule rupture.

3. RF ablation does not require general anesthesia, does not induce scarring of the neck, and when performed by well-trained physicians, is associated with a low complication rate .

4. Complications were reported in 48 patients (3.3%) and major complications in 20 (1.4%).

5. Among the reported sequelae are hypothyroidism in one patient and abscess formation and tumor rupture in one.

6. During the ablation, most patients complain of various degrees of pain in the neck and/or radiating to the head, ear, shoulders, chest, back, or teeth.

7. However, pain decreases rapidly when the generator output is reduced or turned off.

8. Patients may be prescribed painkillers for 2-3 days to reduce post-procedural pain.

9. Voice change is a major complication of RF ablation, caused by damage to the recurrent laryngeal or vagus nerve.
10.Voice change is detected during or immediately after ablation.
11. Voice changes are usually transient, with most patients recovering within 3 months.
12. Prevention of voice change,  use the ‘trans-isthmic approach’ and the ‘moving shot technique’.
13.Using these techniques, unit-by-unit ablation of conceptual ablation units by moving the electrode and undertreatment of the danger triangle (i.e. the area of the thyroid nodule adjacent to the recurrent laryngeal nerve may minimize voice changes.
14. The cervical portion of the vagus nerve is located within the carotid sheath, usually between the common carotid artery and internal jugular vein, however a bulging large thyroid nodule may alter the location of the vagus nerve, making it closer to the thyroid nodule.
15. Check the location of the vagus nerve before RF ablation.
16.There is a potential risk of a sympathetic ganglion damage.
17 If extrathyroidal penetration of a electrode is not detected during the ablation procedure, it may induce ablation injury of sympathetic ganglion because it is located posterior to common carotid artery near the thyroid gland.
18. Continuous and cautious US-guided tracing of the electrode tip is mandatory during the RF ablation.
19. Hematomas, resulting from electrode-induced mechanical injury, can occur in the perithyroidal, supcapsular, and intranodular locations.
20 Hematomas can usually be controlled by mild compression of the neck for several minutes, with most hematomas disappearing within 1 or 2 weeks.
21. Since serious hematomas may compress the airways, close observation is recommended during and after procedure.
22. Serious hemorrhage may be prevented by careful monitoring of the electrode tip (41).

23.Transient thyrotoxicosis may occur after RF ablation, but it is usually normalized within one month.

24. Hypothyroidism has been reported in patients with nonfunctioning thyroid nodules and AFTN

25. To prevent an infection or abscess, the puncture site should be sterilized before RF ablation and prophylactic antibiotics can be used.

26.Thyroid nodule rupture after RF ablation may be suspected in patients complaining of sudden neck bulging and pain at the treatment site.

27. Prior to nodule rupture, the ablated thyroid nodule gradually decreases in size. US examination usually shows a breakdown of the anterior thyroid capsule and the formation of a new nodule in the anterior neck.

28.Delayed sudden perinodular hemorrhage might be a cause of nodule rupture. Spontaneous improvement without treatment is possible, but surgery is required when an abscess forms.

29.During thyroid RF ablation, skin burns have been reported only at the electrode puncture site.

30. Application of an ice bag during the ablation may prevent skin burns at the electrode puncture site.

31. The risk of burns at the grounding pad attachment site is relatively low, because RF energy is lower in the thyroid than in the liver.

32.Nausea and vasovagal reflection may be caused by severe tension, pain, or hypersensitivity to lidocaine.

33.Life-threatening complications, including injury to the trachea and heart attack, have been reported in patients undergoing RF ablation of tumors other than those of the thyroid gland.

34. However, these complications, as well as esophageal rupture, have not been reported yet.

35. Coughing can be induced by thermal propagation to the trachea and is managed by stopping the ablation.

36. To prevent thermal injury to the esophagus, patients should be asked to swallow cold water during the ablation of a conceptual unit adjacent to the esophagus.

37. To prevent life-threatening complications, the operators should strictly trace the electrode tip during the procedure, and should have knowledge of the neck’s anatomy and experience of an image-guided intervention.

Thyroid RF ablation is an effective and safe treatment modality in patients with benign thyroid nodules. RF ablation may be as effective as surgery if it is performed by experienced physicians in optimally selected patients. RF ablation may also have an effective complementary role in the management of recurrent thyroid cancers.

Add Your Comment

Contact Info
1328 16th Street, Santa Monica, CA 90404
Monday – Friday
9:00 AM to 5:00 PM
(310) 393-8860