Keith Forwith

Innovative Thyroid Surgeon

RFA Frequently Asked Questions

Why choose RFA?

  • A nonsurgical approach to reducing the size of the thyroid
  • It leaves no scar whatsoever!
  • It can be safely done in the office; no operating room necessary!
  • It can be done safely and comfortably under local anesthesia!
  • patients can return to work the following day!
  • It produces no damage to normal thyroid tissue so there is no need for hormone replacement!

What is RFA?

RFA stands for radiofrequency ablation and has recently been approved by the FDA for treatment of benign thyroid nodules. Larger nodules can cause trouble swallowing or even trouble breathing. Some nodules are also unsightly. Traditionally, these could only be removed by surgery but now radiofrequency ablation offers a safer alternative.

How does RFA work?

RFA uses a probe guided by ultrasound to selectively apply radiofrequency energy to the interior of a thyroid nodule. This causes the cells within the nodule to die and eventually be resorbed by the body. A typical RFA treatment reduces a nodule size by approximately 80%. Most of this reduction occurs in the first 1 to 3 months following the procedure. However, nodule reduction will continue to occur for up to six months following the treatment.

Is the RFA procedure painful?

The procedure is done under local anesthesia and most patients are quite comfortable during the treatment. The patient is wide-awake which allows constant communication to make sure that there is minimal discomfort. The treatment does not require refraining from eating or drinking either before or after. Patients can eat and swallow normally after the procedure with only mild discomfort.

Our repeated treatments necessary?

Most patients can be treated with a single treatment, so subsequent procedures are not necessary. However, should new nodules arise then the procedure can be safely repeated.

Can substernal goiters be treated by RFA?

Large nodules or goiters which extend below the clavicle can be treated by RFA, however this may be the rare circumstance where more than one procedure is necessary. As the procedure is guided by ultrasound, only the portion of the nodule above the clavicle can be safely visualized during the procedure. However, after RFA treatment of the upper part of a nodule is completed, the part below the clavicle will frequently rise over time into the treatable region where the procedure can be completed at a later date. This is a very safe alternative to a substernal thyroidectomy, which is higher risk than a standard thyroidectomy.

Who can perform the RFA procedure?

RFA is a new procedure to the United States which requires special training. Dr. Forwith has been doing thyroid surgery for more than 20 years but traveled to Brazil to learn the RFA procedure under the guidance of Dr. Leonardo Rangel MD, one of the leading RFA surgeons in the world. In the hands of a skilled surgeon, the procedure is quite safe and effective. Experience with thyroid procedures, intimate knowledge of the unique anatomy of the lower neck, and the awareness of potential injury to surrounding nerves is critical to safe and effective RFA treatment. As with all thyroid procedures, experience, judgment, and skill matter! RFA should only be done by highly experienced thyroid surgeons who have received advanced training in this technique.