Radiofrequency Ablation (RFA) for Thyroid Nodules: An Introduction

Hi, I’m Dr. James Wu. I’m an endocrine surgeon here at UCLA Health, and today I want to talk to you about a treatment that’s changing the way we care for thyroid nodules—something called radiofrequency ablation, or RFA.

Now, if you’ve been told you have a thyroid nodule, you’re not alone. Thyroid nodules are really common—some studies show that up to half of adults have at least one nodule, even if they don’t know it. Most of the time, these nodules are harmless and don’t need any treatment. But sometimes they start to cause problems—like pressure in the neck, trouble swallowing, distortion of the neck and airway. That’s where RFA comes in.

So, what exactly is radiofrequency ablation?

RFA is a minimally invasive way to treat thyroid nodules without surgery. Instead of removing the nodule with an operation, we use heat—delivered through a very fine needle—to shrink the nodule from the inside out. It’s done with just local numbing medicine, no general anesthesia, and no incisions or stitches. That means no scar, very little downtime, and a much faster recovery.

Now, let me walk you through how this works.

These procedures are performed in the Endocrine center in a procedure room, not an operating room. We’ll use ultrasound to guide the procedure in real time. We clean and numb the skin over your thyroid with a local anesthetic. Most people say the numbing part feels like a tiny pinch and a little pressure—very tolerable.

Once the area is numb, we insert a very thin probe—a little smaller than the size of a spaghetti noodle—into the nodule itself. That probe uses radiofrequency energy to heat up the tissue inside the nodule. It’s extremely precise. We move the probe around inside the nodule in a way that targets the whole thing, section by section. This technique is sometimes called the "moving shot" technique. We’re basically sculpting the nodule from the inside, without affecting the rest of the thyroid.

The whole thing usually takes 30 to 60 minutes, depending on the size and location of the nodule. Most people are surprised at how comfortable it is—you’re awake the whole time, talking to us, and we check in with you throughout.

After the procedure, you’ll rest in the clinic for a little while, and then go home the same day. There might be a little soreness, like a bruise in the neck, maybe a bit of swelling for a few days, but most people are back to their normal routine by the next day. That’s a huge contrast to traditional thyroid surgery, which usually involves general anesthesia, an incision in the neck, a few hours in the operating room, and about a week of recovery.

Now, a lot of patients ask me—how effective is it? Will the nodule come back?

That’s a great question. On average, most nodules shrink by 50 to 70 percent within the first 6 after RFA. And the results are long-lasting. Once the nodule is ablated, it typically stays small, and symptoms improve dramatically. Only 6-7% of nodules will regrow after being treated. If it starts to grow again—which is uncommon—it’s possible to do a second treatment. But most patients only need one.

Another common question is—am I a candidate for RFA?

RFA is best suited for people with benign thyroid nodules that are growing, causing symptoms, or causing cosmetic concerns. That means the nodule has already been biopsied and confirmed to be non-cancerous—usually through a fine needle aspirations. It’s also not usually used for multinodular goiters or Graves' disease, although there are some exceptions we can talk about case by case.

In the past, we did not use RFA for thyroid cancer. Our concern was that ablation may not destroy 100% of the cells in the cancerous nodule, and the part that remained inside would grow back and be more difficult to treat. However, as more research is being done in our field, it may be acceptable to perform RFA on small papillary thyroid cancers less than 1 cm in size. Please note, many of those small cancers can observed without any treatment at all. However, we still strongly advise against RFA for other types of thyroid cancer, and any cancer larger than 1 cm.

So, if you’ve had a biopsy that shows the nodule is benign, and it’s causing symptoms—or even if it’s just bothering you because it’s noticeable—RFA might be a really good option. And it’s especially helpful for people who want to avoid surgery, or who aren’t good candidates for surgery because of other health conditions.

One of the other major benefits of RFA is that it preserves thyroid function. In traditional surgery, depending on how much thyroid is removed, you might need to take thyroid hormone replacement for the rest of your life. With RFA, we’re just targeting the nodule—not removing the whole gland—so the healthy part of your thyroid stays intact and keeps doing its job.

So, to sum things up:

RFA is a safe, minimally invasive treatment for benign thyroid nodules.
It’s done under local anesthesia, with no incision and no stitches.
Most people recover quickly, with minimal discomfort.
It’s effective—most nodules shrink significantly and stay small.
And it helps you avoid surgery and keep your thyroid working normally.

Here at UCLA, we’re proud to offer this treatment as part of our comprehensive thyroid care. We’ve seen how much it can improve quality of life for patients who’ve been living with a troublesome nodule for years.

If you’ve been told you have a thyroid nodule and you’re looking for alternatives to surgery—or if you just want to learn more—talk to your doctor or reach out to us at UCLA Health. We’re happy to answer your questions and help you figure out what’s right for you.

Thanks for watching. I’m Dr. James Wu, and I’ll see you next time.