Ways to Treat Thyroid Nodules Without Surgery

Hi, I’m James Wu from the UCLA Endocrine Center. Today, I want to talk about a question we get asked all the time:

How can I manage my thyroid nodules without having surgery?

I’ll cover three main approaches:

1. Observation
2. Minimally invasive procedures, like radiofrequency ablation
3. Medications

Before we dive in, I want to emphasize:

This video is only about benign thyroid nodules. If a nodule has a risk of malignancy or is confirmed to be cancerous, that’s a different topic—and we’ll cover that in another video.

1. Observation

Thyroid nodules are extremely common. By age 50, about 50% of people have at least one. The good news is that most of them are harmless.

Once a nodule has been shown to be benign on biopsy, we don't worry about it turning into cancer.

If you're not having symptoms, such as pressure in your neck or trouble swallowing, then you don’t need treatment. Instead, we can just monitor the nodule over time with periodic thyroid ultrasounds to make sure it’s not growing or changing.

2. Minimally Invasive Procedures

These include:

• Radiofrequency Ablation (RFA)
• Thyroid Artery Embolization

Radiofrequency Ablation (RFA): This is done in the office. We insert a long needle into the thyroid nodule—similar to a needle biopsy. But this needle is connected to a machine that heats the tip.

We use that heat to destroy the nodule from the inside, carefully moving the needle to treat the whole area. The nodule scars down and shrinks, usually to about 30% of its original size. You’ll start to see results in about 6 weeks, with final results in 6 months.

Thyroid Artery Embolization: This is newer and still a bit experimental.

It’s done by interventional radiologists, not surgeons. They insert small catheters into your arteries and block the blood flow to specific parts of the thyroid. With less blood supply, the tissue shrinks—again, down to about 30% of its original volume. This can be especially helpful for large goiters or overgrown thyroids.

3. Medications

There’s no magic pill to make thyroid nodules disappear, but there is a hormone involved in their growth: TSH (Thyroid Stimulating Hormone). If your body is low on thyroid hormone, it increases TSH to stimulate your thyroid to produce more. That stimulation can also make nodules grow.

So, in patients with thyroid hormone deficiency (hypothyroidism), giving low-dose thyroid hormone replacement may help slow nodule growth.  Giving thyroid hormone to people with normal thyroid function has been tried in the past and does not appear to shrink thyroid nodules.

The following is excerpted from the American Thyroid Association guidelines:

In the past, thyroid hormone suppression therapy was used to prevent benign thyroid nodules and enlarged thyroid glands from growing. More recent evidence has shown that this practice is not effective in regions of the world that have adequate iodine intake (such as the USA). Moreover, excess thyroid hormone can increase the risk of heart rhythm problems and bone loss, so this is no longer a standard practice in iodine sufficient populations.

Thyroid Hormone Treatment (American Thyroid Association)

Final Thoughts

To recap, if your thyroid nodule is benign, your options include:

• Doing nothing and just watching it
• Minimally invasive treatments like RFA or embolization
• Medications that might help slow growth, but only if you have hypothyroidism

Thanks for watching! If you want to learn more, please check out our website or explore our other videos. Again, I’m James Wu with the UCLA Endocrine Center.  See you next time.

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