Thyroid RFA: Two visual demos
I’ve been wanting to make this video/write this post for a while now, but I haven’t had a chance! I’ve been so busy! Just this year, I’ve interviewed 5 patients and 20 doctors in 3 different countries and made a total of 124 videos! But now, I wanted to bring you one last video/post before signing off to take a much-needed break for the holidays.
I’m going to show you an example of how thyroid RFA works in layman’s terms. And I’m also going to emphasize 2 important facts about thyroid RFA.
Number 1: Thyroid RFA is a thermal ablation, and
Number 2: Thyroid RFA is only for thyroid nodules.
Let’s dive into those a just little deeper.
What is a thermal ablation?
Thyroid RFA, which stands for RadioFrequency Ablation, is thermal ablation. This means that the procedure uses heat to target and destroy thyroid nodules. Commonly, when people hear the term “radiofrequency,” they incorrectly assume that it means “radioactive.” But this is incorrect. There is no radiation or use of radioactive drugs in RFA.
Radioactive iodine therapy, RAI, is another type of thyroid ablation. But there are several major differences between this treatment and thyroid RFA. RAI is a drug given to a patient that indiscriminately kills the thyroid gland. This is used to treat hyperthyroidism (overactive thyroid) or hot thyroid nodules (nodules producing excess thyroid hormones). Because this treatment kills the whole thyroid gland, it often results in permanent hypothyroidism (underactive thyroid), requiring the patient to take thyroid medication for the rest of the their life. RAI cannot directly target nodules.
Another type of thyroid ablation is chemical ablation. This means that a chemical, usually ethanol, is injected into thyroid nodules -- or more often fluid filled cysts -- to directly target and shrink them. This is referred to as PEI (percutaneous ethanol injection) or EA (ethanol ablation). This is similar to RFA in that it is used to directly target a specific area. When used in cysts, it causes the inside of the cyst to scar over and prevents it from refilling with fluid. In thyroid cysts, it is a very effective treatment option. The main advantage of this procedure is that it is low cost. Ethanol ablation is not without disadvantages, however. The ethanol can leak out of the intended target area and cause some scarring and pain in the surrounding areas.
For solid thyroid nodules, thyroid RFA has an advantage over both of these procedures: Control. Only the tip of the RFA probe heats up, targeting only a very small area. This allows the practitioner to very selectively target just the areas that need to be treated. The remaining thyroid tissue continues functioning as if nothing happened, eliminating any need for thyroid medication after the procedure.
RFA is only for thyroid nodules
A common question I am asked is, “Can thyroid RFA be used to shrink my enlarged thyroid?” The answer to this question is no. Thyroid RFA is used only to directly target a thyroid nodule. If you have an enlarged thyroid without nodules, thyroid RFA is not indicated.
Now on to the demonstration, which will illustrate how thyroid RFA works to target thyroid nodules.
Wood Burning Demo
Earlier this year, I had this great idea to demonstrate how thyroid RFA works using a wood burning tool. I’ve never done wood burning, but I am very much in all things artsy and figured it would be a fun skill to learn. I watched a few videos on the topic, and there are MANY wonderful tutorials about this on YouTube. But I never really had a chance to practice before attempting to make this video. So, be nice!
Here’s my second ever attempt at wood burning. This picture on the left shows what doctors call “the moving shot” technique. The probe is inserted into the nodule from the isthmus (middle) all the way to the back and then gradually moved as small areas are burned. The probe is moved from back to front, working across the nodule until that layer is treated. Now, because this is a flat, 2D example, it doesn't fully demonstrate how a spherical nodule would be treated. But in that case, after the bottom level is treated, the probe would just be moved upward to treat the next level. Repeat until all areas have been treated.
I actually preferred the way this side of the board turned out (below). Unfortunately (when filming) all that you could see was the back of my hand. When I switched out the tip on my wood burner, the tip got cross threaded. After I finally was able to remove it from the tool and replace it with a different one, the new tip would not fully screw into the tool. So, I may have destroyed my wood burning tool! But at least I was able to show you some semblance of what I was going for.
Admittedly, this demonstration was not all that great. I felt like it didn’t do an adequate job of really demonstrating how the procedure works. Because of that, I made another short video; this time using graphics to demonstrate thyroid RFA.
The “graphic” video
Here is the second video I made.
First, the doctor will inject lidocaine into the thyroid. This is so you don’t feel any pain from the heat during the ablation.
Next, the doctor will use ultrasound to find where to insert the RFA probe. The doctor inserts the probe into the middle of the thyroid, called the isthmus. If your thyroid were a butterfly, the isthmus is the body and the lobes are the wings.
Once the probe is inserted all the way to the rear of the nodule, the ablation will be started. Working in very small sections which are just millimeters in size, the nodule is gradually treated. Once the whole nodule has been fully treated, the procedure is complete! Ta da!
Immediately after RFA, the doctor will perform another ultrasound to see how everything looks. The nodule will look very different after RFA. Think about it, when you burn wood, it gets dark and its shape changes. The same is true of when nodules are ablated. On ultrasound, they will become very dark. And as they shrink, they will become slightly irregular in shape. This is completely normal. But I’m going to tell you something VERY important about this: Any future doctor who doesn’t know you’ve had RFA is going to assume very bad things about this thyroid nodule.
The visual characteristics of an ablated nodule can look very suspicious and similar to a cancerous nodule that has not been ablated. To avoid any unnecessary concern, make your future physicians aware of the fact your thyroid nodule has been ablated. Even better, put them in contact with your RFA provider, so together, they can converse about your procedure and clarify everything. Ok, now, where were we?
Over time, your thyroid nodule will shrink. How does this happen? Your body has to dispose of the dead, burnt tissue. This is done by the immune system. Little by little, white blood cells will dispose of the dead tissue, which causes the nodule to shrink! The nodule may never completely disappear, but it will most likely shrink between 50 and 90 percent, which will alleviate any symptoms you were having when the nodule was at its full size. And your thyroid will still function. That’s a win!
Available treatment options
Thyroid RFA is a really amazing treatment option for thyroid nodules. It is one of two thermal ablation procedures available in the United States. To learn about the other one, LASER ablation, watch this video. Stay tuned in 2022 for an updated video on PEI!
Did this visual explanation help you better understand the thyroid RFA procedure? Did my explanation earlier in the post help you to better understand the differences between RFA and other thyroid ablation procedures? If so, please let me know in the comments.
Ways to stay in the know
If you found this explanation helpful, please consider subscribing to my YouTube channel. There, I will always bring you educational content exclusively on the topic of thyroid nodules from the perspective of a patient. To my knowledge, nobody else on YouTube is doing that! So, subscribe and stay in the know.
If you’re looking for support for patients with thyroid nodules, join our Facebook community, “Save Your Thyroid: Nonsurgical Nodule Procedures.” This community is exclusively for patients! There, we provide educational resources, lists of known providers, and much-needed support as you navigate life with thyroid nodules.
Thanks so much for reading. Have a Merry Christmas, a Happy New Year, and I will see you in 2022!
When the time is right, I, the Lord, will make it happen.
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