If you have ever had a thyroid ultrasound and been told you have a “nodule,” do not worry. Thyroid nodules, small lumps that form within the thyroid gland in the neck, are extremely common. High-resolution ultrasound studies suggest that more than four in ten adults have at least one thyroid nodule, although most never feel it or know they have one. Most are harmless, and doctors usually monitor them over time.
However, some nodules can cause symptoms or require treatment. It might grow large enough to press on the windpipe or gullet, causing a tight or choking sensation. It might overproduce thyroid hormone, leading to symptoms such as a racing heart, anxiety or unintended weight loss. A biopsy might also reveal early, low-risk cancer cells. When this happens, patients and their doctors must decide which treatment to pursue. Traditionally, treatment options have included surgery, radioactive iodine or medication, depending on the type of nodule and the symptoms it causes, with each approach having its own benefits and considerations.
Interventional radiologist Dr. Chua Yi Xiu believes a fourth path is now worth considering: radiofrequency ablation (RFA).
Each established treatment involves a compromise.
“For some patients, the decision comes down to balancing the benefits of treating the nodule against the potential need for lifelong medication,” Dr. Chua explains. “Either you live with the nodule and its symptoms, or you accept a treatment that may commit you to medication for life. That is the trade-off we’ve been asking patients to make, and it is exactly the gap that radiofrequency ablation is designed to fill.”
RFA is a minimally invasive, ultrasound-guided procedure. Instead of removing part or all of the thyroid gland, a doctor inserts a very thin, needle-like probe, about the size of an intravenous drip needle, directly into the nodule under continuous ultrasound guidance. The probe then delivers controlled heat to destroy the nodule while preserving the surrounding healthy thyroid tissue.
“The idea is simple: we treat the nodule and the nodule alone, while preserving as much healthy thyroid tissue as possible,” Dr. Chua says. This is RFA's central appeal. Because the healthy portion of the gland continues to function normally, many patients can avoid lifelong hormone replacement that often follows surgery or radioactive iodine.
The procedure is typically done under local anaesthesia with sedation as a day surgery, meaning patients can go home the same day. It requires only one or two small needle punctures in the neck, with no stitches needed afterwards.
RFA is most commonly used for benign nodules that cause visible swelling, compressive symptoms, or cosmetic concerns. It is also considered for “toxic” nodules, those that are overactive and driving symptoms of an overactive thyroid, where burning off the single culprit nodule can resolve the problem without a full course of antithyroid medication or surgery.
Dr. Chua highlights patients who have already had one lobe of their thyroid removed as a group that may particularly benefit from RFA.
“If a patient has already had a hemithyroidectomy and a new nodule later develops on the remaining half of the thyroid, a second surgery would almost certainly mean they need thyroid hormone replacement for the rest of their life,” he explains. “That is one of the most compelling reasons to reach for RFA instead of going back to the operating theatre.”
RFA may also be used selectively in some patients with small, low-risk thyroid cancers or a cancer recurrence, particularly those who are not suitable for or decline further surgery. This approach requires careful patient selection. For larger or more aggressive cancers, surgery remains the standard treatment. RFA may be considered for selected small cancers or recurrences when the tumor can be treated safely and completely.
Not all thyroid nodules are alike, and neither is their treatment. Cystic nodules, which are largely fluid-filled, may be better suited to ethanol sclerotherapy rather than RFA.
Before RFA, patients typically undergo blood tests, including thyroid function tests, and a review of any medications, particularly blood thinners, which usually need to be paused beforehand. Because RFA permanently changes the treated tissue, doctors usually want to confirm that the nodule is benign before proceeding.
“We are careful before treating any nodule,” Dr. Chua notes. “In most cases, we want the nodule biopsied twice and confirmed benign before ablation, because a nodule that has already undergone ablation can be much harder to biopsy or assess accurately afterwards if there are ever concerns later on.”
Patients remain awake during the procedure and receive local anaesthesia around the treatment area. Some discomfort may occur, but the care team monitors patients throughout and provides additional anaesthetic support / sedation if needed.
Dr. Chua says one of the most important things for patients to understand is that RFA does not work instantly. “Unlike surgery, where the nodule is simply removed and gone, ablation is a gradual process. The results are gradual, so patients should not expect the nodule to disappear immediately. Visible shrinkage happens around the three- to six-month mark, and the nodule can continue to shrink further over the following 1-2 years.” Larger nodules sometimes require more than one treatment session to achieve the desired result.
The evidence base for RFA has grown substantially over the past decade. A review of thyroid RFA studies found that thyroid nodules can shrink substantially after RFA, with the greatest reduction occurring over the first one to two years. Alongside this shrinkage, most patients report meaningful improvement in compressive symptoms and cosmetic appearance.
Studies have also reported a low overall complication rate, with a clinical review of RFA complications across multiple large studies finding an overall complication rate of approximately 2-3%, with serious or permanent complications occurring in well under 1% of cases. One of the main risks is injury to the recurrent laryngeal nerve, which controls the vocal cords and can cause hoarseness. Most reported nerve injuries are temporary, while permanent voice changes are uncommon.
“Recurrent laryngeal nerve injury is the specific risk we always counsel patients about,” Dr. Chua elaborates. “The good news is that when it happens, it is usually transient. Permanent injury is uncommon, but this is why careful ultrasound guidance and knowledge of the neck anatomy are important.”
Other possible but uncommon complications include minor bleeding under the skin, nodule rupture, transient changes in thyroid hormone levels, skin burns, and, rarely, injury to nearby nerves in the shoulder region.
Radiofrequency ablation has not replaced surgery, radioactive iodine, or medication, and it isn't suitable for every nodule or every patient. But for the right patient, particularly someone hoping to avoid an operation, preserve their remaining thyroid function, or sidestep a lifetime of hormone replacement tablets, RFA offers a different way forward.
As Dr. Chua puts it, the goal is to give patients more options. “Not every nodule needs treatment, and not every nodule that needs treatment needs surgery. What we want is for patients to have a real conversation with their doctor about what matters most to them, whether that’s avoiding a scar, avoiding lifelong medication, or simply feeling comfortable in their own neck again, and to choose the option that fits their situation best.”
If you have a thyroid nodule and are exploring your options, ask your doctor whether radiofrequency ablation may be suitable for you.
