Thyroid Nodule Treatment

Interventional endocrinology is an emerging field that uses percutaneous (through-the-skin), image-guided procedures to treat endocrine diseases — using far less invasive techniques than traditional surgery. The most commonly performed procedures include ultrasound-guided ethanol ablation and ultrasound-guided radiofrequency ablation (RFA) of specific types of benign thyroid nodules, as well as treatment of lymph nodes with recurrent thyroid cancer.

A thyroid nodule is a growth of thyroid tissue or a fluid-filled cyst that forms within the thyroid gland. They are extremely common — approximately 75% of all people will develop a thyroid nodule during their lifetime, most without knowing it. Problems arise when nodules grow large enough to interfere with breathing or swallowing, cause excess hormone production, or create cosmetic concerns.

Traditionally, thyroid surgery or radioactive iodine were the only treatment options for problematic nodules. Non-surgical ablation techniques have changed that.

Thyroid RFA uses a small needle that delivers precisely controlled radiofrequency energy to heat and destroy nodule tissue. The same technology is used to treat tumors in the liver, lung, kidney, breast, and bone, and has been used for thyroid tissue worldwide since 2002.

RFA is performed in-office under local anesthesia. Patients are awake and able to breathe and speak throughout the procedure. After numbing the neck, Dr. Schneider inserts a small needle under continuous ultrasound guidance and moves it through the nodule using the “moving shot” technique until the entire nodule has been ablated. The procedure takes approximately 15 to 30 minutes depending on nodule size. Patients can resume normal activities the same day.

RFA is considered successful when the nodule shrinks by more than 50%. On average, thyroid RFA shrinks solid thyroid nodules by 80% (range: 65–94%). Most patients experience complete or near-complete resolution of compressive symptoms and cosmetic concerns. Approximately 80–90% of patients achieve excellent outcomes with a single session. For very large nodules, a second session may be needed.

For hyperfunctioning (autonomously active) nodules, hyperthyroidism resolves in 50–80% of patients. Results develop gradually — significant shrinkage occurs within the first month, with continued reduction for up to a year after the procedure.

RFA is a very gentle, minimally invasive procedure. There is no incision, no neck scar, and no general anesthesia. Recovery time is very short. Unlike surgery, RFA spares healthy thyroid tissue — most patients do not require lifelong thyroid hormone replacement after the procedure.

Our focus is making thyroid RFA safe, effective, accessible, and affordable — by eliminating hospital, surgical center, and anesthesia costs. The procedure is performed entirely in our office with local anesthesia. The cost of thyroid RFA without insurance coverage is between $3,500 and $4,500. We work with your insurance company to determine coverage, benefits, and out-of-pocket cost. We recommend requesting a second opinion before committing to surgery or RFA with another physician.

PLA uses laser light delivered through an optic fiber via a needle inserted into the nodule. The laser energy causes heat-induced ablation of the tissue. PLA uses less energy than RFA, making it more precise but slower in achieving results — making it the preferred approach for very large nodules or in specific anatomical situations where precision is paramount.

Like RFA, PLA is performed in-office under local anesthesia with real-time ultrasound guidance. No hospitalization is required.

Ethanol ablation uses high-resolution ultrasound to guide the injection of a small amount of ethanol (alcohol) directly into a thyroid nodule or lymph node. The ethanol causes a controlled inflammatory response that selectively destroys the nodule tissue.

This procedure is particularly effective for cystic (fluid-filled) thyroid nodules, which are almost never cancerous (<1% for simple cysts) and carry a very low risk of malignancy (<3%) even when partially cystic. Ethanol ablation is considered when compressive symptoms are present or when the cyst is large — especially for patients in whom needle aspiration has failed (aspiration alone has a 60–90% recurrence rate). Patients with cystic thyroid nodules should not undergo neck surgery before considering non-surgical approaches.

These procedures require unique, specialized training to be performed safely and with good results. Dr. Schneider has unparalleled expertise in clinical thyroidology and ultrasonography, and was trained in ultrasound-guided interventional techniques by Dr. Korkusuz in Frankfurt, Germany — a pioneer in the field. His combined expertise in clinical thyroidology, interventional endocrinology, and ultrasonography is unique in San Diego.

A multidisciplinary discussion among specialists is critical to determining candidacy. We work closely with head and neck surgeons, nuclear medicine physicians, and radiologists when evaluating patients for these procedures.

If you are interested in RFA, PLA, or ethanol ablation and would like to discuss whether you would be a good candidate, please contact us to schedule a consultation.