CANCER, OTHER SERVICES & SPECIALTIES

Radiofrequency Ablation for Thyroid Nodules: A Minimally-Invasive Procedure Emerges At Last

June 29, 2022 - Eden McCleskey

Minimally invasive surgery options may seem ubiquitous these days — from breast augmentations to brain surgeries to major spinal deformity corrections — but not every field has been able to take advantage of the well-publicized benefits of the approach.

Thyroid surgeries, for instance, have been noticeably absent from this revolution.

Until recently, that is.

With the launch of its new radiofrequency ablation (RFA) program, led by high-profile recruit Dr. Helmi Khadra, Houston Methodist Hospital has joined an elite group of only 15-20 centers nationwide offering this innovative minimally invasive treatment for thyroid nodules.

Adapting the technology for tricky terrain

RFA uses ultrasound guidance and high intensity radio waves to shrink (or "cook") tumors, nodules and other growths. Although the technology has been used clinically for decades in other fields, it only recently evolved to make it safe to use in the neck, where complex and critical functions are tightly concentrated.

In 2018, the FDA approved RFA for use on benign compressive thyroid nodules. Indications have since expanded to include malignancies under 1 cm and metastatic tumors of the neck lymph nodes.

"Radiofrequency ablation is rapidly gaining momentum and evolving into the preferred standard of care for many patients with select thyroid nodules, assuming you can find a center that provides it," Dr. Khadra says.

The issue isn't that the equipment is new or rare; it's that so few surgeons are trained in how to use it.

"The thyroid sits on top of the windpipe, esophagus and an important nerve that controls our vocal cords, and between the carotid arteries, jugular veins and important nerves," Dr. Khadra explains. "It's tricky controlling the heat in this area without damaging anything. That's why there was a lot of hesitancy adapting it for use in the thyroid."

Benefits of radiofrequency ablation

When compared to open thyroidectomy, the advantages of RFA speak for themselves. With surgery, patients will have a visible scar on their neck; the surgery itself is longer and requires general anesthesia; the recovery time is longer, with more chance for infection and complications; and the removal of the entire thyroid makes patients dependent on replacement hormone medication for the rest of their lives.

With RFA, the patient instead receives local anesthesia, can leave immediately after the procedure and return to work the next day, has no visible scarring and typically retains a fully functioning thyroid.

"It's a significant game-changer for patients and physicians alike," Dr. Khadra says. "Demand is strong and only growing, and it will be a challenge to meet it until more surgeons are trained and experienced enough to provide it."

A fast-changing landscape

Indeed, within only a few months of Dr. Khadra's arrival and initiation of the RFA thyroid program, Houston Methodist has already become the highest volume provider in the Houston area, which boasts the largest medical center in the world.

Dr. Khadra estimates the program is on track to provide over 200 RFA procedures per year.

Will it replace thyroid surgery entirely?

"No, probably not," Dr. Khadra says. "For patients with thyroid cancer, unless you've caught it at a very early stage with certain features, it will still be best to remove the thyroid. It makes it easier to monitor for recurrence, and the synthetic hormones actually help prevent the cancer from coming back."

But because over 85% of thyroid nodules are benign, a significant portion of thyroid surgery volume will likely be heading the way of the Dodo bird soon. And that's OK.

"We all want what's safest and easiest for our patients," Dr. Khadra says. "Every surgeon wants that, so we welcome innovations like this, even if it means we have to change."

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Surgical Case