Thyroid Nodule
RFA Ablation Specialist

1.) Possible acute side effects of radiation therapy include neck discomfort, nausea, vomiting, loss of taste, salivary gland pain and swelling (sialoadenitis), dry mouth, and sore throat. Also, temporary infertility in men who receive RAI therapy for thyroid cancer can occur. Some studies suggest that radiation-induced cancer risks following RAI therapy for hyperthyroidism are small and that these may be higher after high-dose therapy. (1,2)

2.) Due to targeted therapy, hypothyroidism is extremely rare after thyroid RFA. (3,4)

3.) Damage to the parathyroid glands or their removal during a thyroid nodule surgery can cause transient or permanent hypocalcemia. Some studies have shown a 27% risk of hypothyroidism after hemithyroidectomy. (5,6)

4.) Hypothyroidism or underactive thyroid is an expected side effect of RAI therapy. The incidence of hypothyroidism following RAI therapy is going to be determined by the number of sessions and the dose as well. (1,7)

5.) The risk of developing problems with thyroid function after thyroid RFA is very rare. Therefore, there is no need for hormone replacement therapy in the majority of cases. (3,4)

6.) Hormone replacement therapy is required in patients after total thyroidectomy. Due to the complete removal of the thyroid gland, these patients are going to need to take a pill containing synthetic thyroxine (T4). This drug is going to work the same way as the patient’s thyroid hormone would. (5)

7.) Hypothyroidism or underactive thyroid is an expected side effect of RAI therapy because normal functional tissue is also destroyed in the process. Generally, a low-dose thyroid hormone replacement (manmade thyroid hormone) is started before hypothyroidism ensues. The most commonly prescribed is pure synthetic thyroxine (T4). (1,7)

8.) Due to the targeted nature of this procedure, it usually results in minimal or no damage to surrounding thyroid tissue. (8)

9.) Total thyroidectomy results in complete removal of the thyroid gland. Therefore, it is going to remove both normal and affected thyroid tissue altogether. On the other hand, a lobectomy only removes the affected lobe, leaving viable thyroid tissue unaffected. The choice between these two procedures is going to be made according to the underlying condition. (5)

10.) Radioactive iodine therapy damages both normal and affected thyroid tissue. (1, 7)

11.) This procedure is usually well-tolerated and has a very low incidence of complications (2.11% for benign nodules and less than 11% for recurrent thyroid cancer). The most common minor complaint is pain which is usually tolerable and easily managed with NSAIDs. (8)

12.) The complication rate of this procedure is relatively low. Some studies have shown a 7.74% complication rate for both inpatient and outpatient procedures. (5)

13.) RAI therapy complication rates are going to be affected by the number of sessions and dosage. However, it usually has a low rate of complications associated. (1,7)

14.) Patients are usually discharged on the same day of the procedure. They may experience bruising that usually resolves in 1 or 2 weeks. Even though this procedure is quite painless, some patients may experience mild discomfort. Usually, the patient can return to normal activities the next day. However, avoiding heavy lifting and other activities that may cause neck pain is always advised. (12)

15.) Neck pain is a common complaint after surgery and it is usually managed with nonopioid drugs. Hoarseness and neck pain should resolve within the first week after the surgery if no major complications happened during the procedure. Patients are instructed to avoid heavy lifting and strenuous exercise routines for 10 days. Other than that, they may go back to their usual routine within a week after surgery. (11)

16.) In most cases, thyroid hormone levels will return to normal (or below normal) after a single dose of treatment. This may take around 2-5 months. Importantly, patients will be radioactive after treatment for several days. Thus, certain safety precautions to protect others from radiation should be taken. (9, 10)

17.) Thyroid nodule surgery can be performed as an outpatient procedure. However, many surgeons prefer to leave their patients on observation for the night, especially if they have a high risk of postop bleeding. Additionally, calcium levels need to be measured to rule out iatrogenic hypoparathyroidism. (13)

1.) Padda, I. S. (2021, June 2). Radioactive Iodine Therapy. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557741/.

2.) 10. Shim, S. R., Kitahara, C. M., Cha, E. S., Kim, S.-J., Bang, Y. J., & Lee, W. J. (2021). Cancer risk after radioactive iodine treatment for hyperthyroidism. JAMA Network Open, 4(9). https://doi.org/10.1001/jamanetworkopen.2021.25072

3.) Che, Y., Jin, S., Shi, C., Wang, L., Zhang, X., Li, Y., & Baek, J. H. (2015). Treatment of benign thyroid nodules: Comparison of surgery with radiofrequency ablation. American Journal of Neuroradiology, 36(7), 1321–1325. https://doi.org/10.3174/ajnr.a4276

4.) Sung, J. Y., Baek, J. H., Jung, S. L., Kim, J.-hoon, Kim, K. S., Lee, D., Kim, W. B., & Na, D. G. (2015). Radiofrequency ablation for Autonomously Functioning Thyroid Nodules: A Multicenter Study. Thyroid, 25(1), 112–117. https://doi.org/10.1089/thy.2014.0100
5.) Pramod K Sharma, M. D. (2021). Complications of thyroid surgery. Practice Essentials, Overview, Bleeding. https://emedicine.medscape.com/article/852184-overview#a1

6.) Chotigavanich C; Sureepong P; Ongard S; Eiamkulvorapong A; Boonyaarunnate T; Chongkolwatana C; Metheetrairut C. Hypothyroidism after hemithyroidectomy: The incidence and risk factors. Journal of the Medical Association of Thailand https://pubmed.ncbi.nlm.nih.gov/27455828/.

7.) Husseni, M. A. (2016). The incidence of hypothyroidism following the radioactive iodine treatment of graves’ disease and the predictive factors influencing its development. World journal of nuclear medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4729012/.

8.) Kim, J.-hoon, Baek, J. H., Lim, H. K., Ahn, H. S., Baek, S. M., Choi, Y. J., Choi, Y. J., Chung, S. R., Ha, E. J., Hahn, S. Y., Jung, S. L., Kim, D. S., Kim, S. J., Kim, Y. K., Lee, C. Y., Lee, J. H., Lee, K. H., Lee, Y. H., Park, J. S. Guideline Committee for the Korean Society of Thyroid Radiology (KSThR) and Korean Society of Radiology. 2017 thyroid radiofrequency ablation guideline: Korean Society of Thyroid Radiology. https://doi.org/10.3348/kjr.2018.19.4.632

9.) Radioactive Iodine. American Thyroid Association. Retrieved October 1, 2021, from https://www.thyroid.org/radioactive-iodine/.

10.) Lee, S. L. (2020, December 5). What monitoring is needed after radioactive iodine therapy for hyperthyroidism? Medscape. Retrieved October 1, 2021, from https://www.medscape.com/answers/121865-25290/what-monitoring-is-needed-after-radioactive-iodine-therapy-for-hyperthyroidism

11.) Perry, E. (2019, September 7). Thyroid surgery patient information: Johns Hopkins Medicine in Baltimore, MD. Thyroid Surgery Patient Information | Johns Hopkins Medicine in Baltimore, MD. Retrieved October 2021, from https://www.hopkinsmedicine.org/surgery/specialty-areas/surgical-oncology/endocrine/patient_information/thyroid_surgery.html.

12.) Mount Sinai Surgeon performs radiofrequency ablation for thyroid nodules. Mount Sinai Health System. Retrieved Octobe, 2021, from https://www.mountsinai.org/about/newsroom/2019/mount-sinai-surgeon-performs-radiofrequency-ablation-for-thyroid-nodules#:~:text=Patients%20who%20undergo%20RFA%20can,require%20permanent%20thyroid%20hormone%20medication.

13.) Balentine, C. J; Sippel, R. S. (2016, January). Outpatient thyroidectomy: Is it safe? Surgical oncology clinics of North America. Retrieved October, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134424/.