Category: Thyroid

Monitor: 5

5 - Radio frequency ablation of a toxic nodule and its effects on nodule Vascularity volume and thyroid function

Thursday, Apr 25
1:00 PM – 1:30 PM

Objective :

This case report describes the first successful RFA of an AFTN in North America using local anesthesia. This case shows the efficacy of radiofrequency thermal ablation to mitigate the vascularity inside a toxic nodule through artery/vein ablation. Our case report shows complete, successful ablation of the patient’s AFTN.

 RFA, new in the USA, offers a minimally invasive, less risky outpatient treatment option to traditional RAI therapy of AFTN. RFA effectively ablates benign thyroid nodules using a trans-isthmic approach. Our case report shows successful ablation of an AFTN without complications and with minimal recovery time. This includes marked volume reduction in the AFTN and rapid normalization of TSH in the patient.

Methods :

35-year-old mother of 3 with a right-sided thyroid lump, U/S showed a 1.1 cm volume nodule with TSH of 0.32, free T4 of 1.39. The patient did not want traditional surgery and opted for RFA.



Vascularity of the nodule was assessed using color Doppler images and classified as Vascular grade 3: Nodules are graded: 0 (no tumor signal), 1 (few spotty signals tumor), 2 (< 25% signals in tumor), 3 (25–50% signals in tumor), 4 (> 50% signals in tumor).


Pre-ablation nodule vascularity showed a hyperemic nodule (AFTN) grade 3. US-guided RF ablation was performed with an RF generator and 18-gauge 0.7 cm tip internally cooled antenna. The Danger triangle and Vagus nerve were visualized prior to antenna insertion. After electrode inserted into the nodule ablation was performed using 30 W of RF power.

 A transient hyperechoic zone appeared at the periphery of the nodule within 5-10 seconds. The procedure was terminated when the entire visualized area of the nodule became a transient hyperechoic zone and no Doppler flow was noted. Active ablation time: 4 min 20 sec. No complications occurred.

Results :

11 days post- ablation the nodule was an avascular (AFTN) grade 0. with 44.4% volume reduction in nodule size. TSH was 0.30 pre-ablation, 0.51 post ablation.




Discussion :

RF ablation was recently introduced as an alternative to treat AFTN. Trans-isthmic approach with moving-shot technique is standard and well validated. This approach helps to avoid treatment failure and nodule regrowth. Success of RFA ablation can be predicted by absence of vascularity in the nodule after the procedure.



Conclusion :

 RFA is an effective method for treating benign thyroid nodules with efficacy rate of 80-85% to attain euthyroid state. 


Shahzad Ahmad

managing Partner , The Thyroid Clinic LLC
Draper, Utah

Dr. Ahmad completed his residency in Internal Medicine at Mount Sinai School of Medicine in Englewood, New Jersey and then went on to an Endocrinology fellowship at Harbour-UCLA. His special focus is on the diagnosis and medical treatment of thyroid dysfunction, nodules, and
cancer. He also was an assistant professor at the University of San Francisco School of Medicine .

Dr Ahmad Is ECNU certified, which is a professional certification awarded to Endocrinologists who have expertise in thyroid ultrasound and procedures

Jules Aljammal

The Thyroid Clinic

Dr. Aljammal is a dedicated doctor who has a passion for providing the highest standard of medical care for his patients. Dr. Aljammal graduated from one of the U.S. top rated academic hospitals, University of Pittsburgh Medical Center, where he trained with national leaders in endocrinology. He is board-certified in endocrinology and has expertise in the evaluation and treatment of thyroid diseases. Dr Aljammal is also ECNU certified

Ali Shahzad