Radiofrequency Ablation (RFA) for the Treatment of Thyroid Nodules

Thyroid ablation is a procedure where nodules within the thyroid gland are destroyed by a needle inserted through the skin. The needle tip is heated by an electric current, which destroys a small area of thyroid tissue.

We have used RFA at UCLH to treat other organs for over 10 years. RFA of the thyroid has been performed at UCLH since 2017.

The aim of this treatment is to destroy the nodule within the thyroid, and shrink the gland.

The main risks are damage to blood vessels and bleeding as the needle is inserted, hoarseness of voice and a burn of the skin. Rarely the oesophagus (swallowing tube), trachea (wind pipe) and the nerve to the vocal cords (voice box) can be injured. The treated nodule may rupture. In extremely rare cases, patients with thyroid nodules treated with RFA have died.

Problems that may happen straight away

Bleeding from the needle insertion site and burning of the skin. This normally requires no treatment. Hoarseness of voice normally resolves within a few hours of the procedure.

Problems that may happen later

There is a small risk (less than 1 person in 100) of infection following this treatment. We will advise you to look out for worsening swelling, pain or redness. There is a small risk (3 persons in 100) that the nodule being treated with RFA ruptures in the neck, this will present a few weeks after treatment with sudden swelling and pain in the neck at the site of treatment.

Problems that are rare, but serious

There is a small risk (less than 1 person in 100) of permanent injury to the nerve to the voice box leading to alteration of your voice. There have been very rare cases of death associated with this procedure.

If you do not want to have this treatment, you should discuss this with your doctor.

Your doctor will discuss with you the best course of treatment in your case.

We will invite you to come for Ultrasound Guided Fine Needle Aspiration (FNA) before your treatment. Two FNA results are required before ablation can be carried out (if this has been performed at a different hospital, we will contact them to request a copy of the results). At your endocrine surgery appointment, we will ask you about your medical history to ensure you are well enough for the procedure to go ahead. When we have the results of the FNA, the RFA Coordinator will call to arrange the RFA appointment date.

We will send you written information that tells you about eating and drinking before your procedure, what to bring with you, when you should arrive and the need to have an escort home.

The co-ordinator will ask you about any medicines or tablets that you are taking – either prescribed by a doctor or bought over the counter in a pharmacy. It helps us if you bring written details of your medicines with you to the ultrasound appointment.

We will tell you whether you need to stop taking any of your medicines before your procedure. When you come into the hospital for the RFA procedure, please bring all of your medicines with you.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.

The consent form is a form that both you and the operating doctor sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the interventional procedure. (You can have a copy of this form to take with you.)

Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.

You will be instructed where to attend your ablation appointment. The procedure is commonly performed in an operating theatre and you will be asked to present to surgical reception in the main UCLH building on Podium Floor 1.

You will have a local anaesthetic injection to numb the skin. A treatment needle will be inserted through the skin into the thyroid, guided by an ultrasound scanner. Several small ablations will be performed as the needle is moved through the thyroid nodule.

Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful.

Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Usually, the ablation itself takes up to 1 hour, and you will be observed in the treatment room for 1 hour.

After your treatment you will be observed in the treatment room for 1 hour. You may have some pain and discomfort, but we can give you some pain relief to help with this.

Before you leave the hospital, we will check that you do not feel sick, that you can eat and drink, and that you do not have significant pain.

By the next day most people require pain relief no stronger than paracetamol.

We will provide you with written instructions to follow when you leave the hospital, and the contact numbers of the team in case of emergency.

What happens when I go home?

Normally, you will be able to go home a few hours after your procedure. You should expect to be off work for 2-3 days after treatment.

A follow-up ultrasound appointment will be arranged for 1 month and 6 months after the procedure.

The endocrine surgery team will call you the day after the RFA procedure to check you are recovering well and the following week to check on you again and will arrange the follow-up scans.

Signs to look out for:

• Difficulty swallowing or shortness of breath
• Pain that is not controlled by regular simple pain relief (for example paracetamol)
• Fever, skin redness or increasing pain and swelling more than 1 week after the procedure

If you experience any of these symptoms you should seek urgent medical advice in your local emergency department.

If you have any concerns or questions following discharge, please contact the clinical nurse specialist on 0203 456 8066.

If you need to see your GP after the treatment please take your post discharge instructions with you.

National Institute for Clinical Excellence (NICE)

UCH cannot accept responsibility for information gained from external organisations.

Please contact the Clinical Nurse Specialist (CNS)

Clinical Nurse Specialist:
Direct line: 0203 456 8066

RFA Thyroid Service
Imaging Department
Ground floor
UCH - Grafton Way Building
1 Grafton Way
London
WC1E 6AS

UCH Switchboard: 020 3456 7890

Procedures

Ultrasound and FNA appointments:
Royal National ENT and Eastman Dental Hospital (Basement-2) OR University College Hospital (main tower, lower ground floor)

Thyroid ablation procedure:

University College Hospital (main tower)

Travelling to the hospital

No car parking is available at the hospital. Street parking is limited and restricted to a maximum of 2 hours.

Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.

Tube
The nearest tube stations, which are within 2 minutes’ walk are:

• Warren Street (Northern and Victoria lines)
• Euston Square (Hammersmith & City, Circle and Metropolitan lines)

Overground trains
Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.

Bus
Further travel information can be obtained from the TFL website or you can call 020 3054 4040 14

Hospital transport service

You will need to call at least seven days before your appointment.

If you feel that you are eligible for transport please call: 020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team. Calling is preferable, as you will be asked some questions however if this is not possible email: uclh.transport.department@nhs.net

If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please call 020 7380 9757 to cancel your transport.

Can an escort be arranged to accompany me in hospital transport?

This will depend on your clinical condition or mobility. If you meet the criteria then an escort will be booked to accompany you to and from the hospital. However, we aim to keep these to a minimum as escorts take up seats that would otherwise be used for patients.

University College Hospital Area Map