Toxic Thyroid Nodules: RFA vs. RAI—What Patients Need to Know with Dr. Ian Orozco
SAVE YOUR THYROID with Jennifer Holkem
When Your Thyroid Nodule Is Toxic—What Are Your Real Options?
If you or someone you love has been diagnosed with a toxic thyroid nodule (producing excess thyroid hormones), chances are you’ve heard terms like radioactive iodine (RAI) and radiofrequency ablation (RFA) tossed around. But what do they mean? How do they work? And—most importantly—how do you decide what’s right for you?
In this episode, I sat down with Dr. Ian Orozco, an endocrinologist in Provo, Utah, who specializes in thyroid and parathyroid disorders. Dr. Orozco has deep experience treating toxic nodules with both RAI and RFA, making him the ideal person to help patients—and clinicians—understand the key differences, risks, and benefits of each option.
🎧What You’ll Learn in This Episode:
What a toxic thyroid nodule is and how it differs from other types of nodules
The symptoms of toxic nodules
Key differences between Radioactive Iodine (RAI) and Radiofrequency Ablation (RFA)
Why RAI may not always lead to permanent hypothyroidism—if properly tailored
How RFA is performed, what it feels like, and why it’s a minimally invasive option
Why RFA can preserve thyroid function when used appropriately
Which patients make ideal candidates for RFA—and who may need surgery or RAI instead
Why choosing the right specialist—not just any doctor—is critical
Real-world considerations like cost, insurance coverage, and patient lifestyle when choosing a treatment
Why patient education and second opinions are essential for navigating thyroid treatment options
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What is this podcast and blog all about?
To my subscribers, welcome back! If you’re new, welcome to Save Your Thyroid with Jennifer Holkem, a podcast and blog all about thyroid nodules. For the past 6 years, I have advocated for fellow patients suffering with this very common condition.
Thyroid nodules impact 70% of adults in their lifetime, and the standard of care is surgical removal of half or all of the gland. But in recent years, safe and effective non-surgical treatment options have become available.
In this podcast and blog, I sit down with patients and physicians to discuss life with thyroid nodules, treatment options, and how to save the thyroid whenever possible.
What Is a Toxic Thyroid Nodule?
Unlike common thyroid nodules that are typically harmless or cause cosmetic issues, toxic nodules actually produce thyroid hormone—enough to make you sick. Dr. Orozco explains that these nodules lead to hyperthyroid symptoms like:
Rapid heartbeat
Heat intolerance
Unintentional weight loss
Jitteriness
Difficulty sleeping
And unlike Graves’ disease, which affects the whole thyroid, toxic nodules are usually localized, making them potentially more targeted for treatment.
The Treatment Landscape: RAI and RFA
Radioactive Iodine (RAI)
RAI is a long-established treatment that involves taking a radioactive pill to destroy overactive thyroid tissue. While effective, it comes with some significant downsides:
Potential for permanent hypothyroidism
Isolation for 7–14 days due to radiation
Not ideal for women of childbearing age due to risks of early menopause and increased breast cancer risk
Not suitable for caregivers or people who can't easily take time away from others
Dr. Orozco emphasized that correct dosing is critical with RAI. A tailored approach—taking into account nodule size and uptake on imaging—can significantly reduce the chance of long-term hypothyroidism, especially when overseen by a skilled endocrinologist.
Radiofrequency Ablation (RFA)
RFA is a non-surgical, outpatient procedure that uses targeted heat to destroy the nodule from the inside—without harming the rest of the thyroid.
No radiation
No hospital stay
Minimal downtime
Preserves healthy thyroid tissue
Ideal for smaller, solid nodules
But here’s the catch: for RFA to be effective on a toxic nodule, the entire nodule must be destroyed. Unlike with large, cold nodules (those not producing excess hormones), shrinking part of a toxic nodule isn’t enough—if any tissue remains, the hyperthyroidism may continue or return later.
Choosing the Right Treatment: It's Not One-Size-Fits-All
Dr. Orozco breaks it down like this:
Surgery is the most universally effective but carries the highest risk of hypothyroidism.
RAI is effective but involves radiation exposure, isolation, and potential long-term risks—especially for younger women.
RFA is ideal for small, solid toxic nodules—but not for everyone. Larger or cystic nodules may require multiple sessions or be better suited to another treatment.
He also warns that if you try RFA first and it doesn’t fully ablate the nodule, you may no longer be a good candidate for RAI—because the tissue left behind might not absorb the radioactive iodine well.
Key Takeaways for Patients
Always get a second opinion—preferably from a thyroid specialist who understands all treatment modalities.
Don’t confuse RFA and RAI—they sound similar but are completely different in approach, outcome, and lifestyle impact.
Ask your doctor if they tailor RAI doses to your specific nodule—a one-size-fits-all dose may increase the risk of unwanted side effects.
RFA should be considered a first-line treatment—especially for women of childbearing age who want to avoid radiation and preserve thyroid function.
What's Next in Thyroid Care?
Dr. Orozco shared some exciting developments on the horizon, including:
Using RFA for recurrent thyroid cancer in lymph nodes
Emerging techniques like microwave ablation and nanopulse wave technology
Possible future applications of RFA for parathyroid disorders
But as with any new technology, success depends on the right patient, the right condition, and the right doctor.
Final Words of Advice
“If you have the means,” Dr. Orozco says, “see a thyroid doctor.”
Whether you're considering surgery, RAI, or RFA, the best outcomes come from working with someone who lives and breathes thyroid care.
This episode is packed with practical, honest information that every patient with a toxic thyroid nodule should hear. Listen, take notes, and most of all—advocate for yourself.
🎧 Listen to the full episode on your favorite podcast platform or at SaveYourThyroidWithJen.com
Learn more about Dr. Ian Orozco:
Thank you to the sponsor of this episode, Cambridge Interventional.
Cambridge Interventional, a US-based company, has decades of experience in development, manufacturing, and sales of RFA and other medical devices. Radiofrequency ablation is a nonsurgical, minimally invasive, thermal ablation procedure used to treat various tumors, including thyroid nodules. If you have followed this blog for very long, you probably know that I personally underwent thyroid RFA treatment for a very large thyroid nodule and was able to avoid surgery and save my thyroid. If you’d like to learn more about Cambridge Interventional, please visit their website CambridgeInterventional.com. A big thanks goes out to Cambridge Interventional for helping physicians to save thyroids, and also for supporting this channel by sponsoring this episode.
👉Learn more about Cambridge Interventional
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Disclaimer: None of the statements made in this or any other blog/video by "Its me Jen again" should be considered medical advice.
The goal of this podcast and blog
I seek to provide data, resources, and expert opinions on the topic of thyroid nodules, and make it accessible to patients. When I was first looking for thermal ablation treatment, everything that I read was physician-facing material. It was very hard for me to understand. This material is meant to help patients understand what's going on in their thyroid gland and what an important gland it is. If you can keep your thyroid intact, that's going to help you live a longer, healthier life, and preserve your quality of life. Thanks for reading this far today! — Jen