Stanford Health Care introduces new, less invasive treatment for benign thyroid nodules

A recently approved technique for radio-frequency ablation treats or prevents problems caused by thyroid nodules, providing an alternative to surgical removal of the gland.

Sarah O’Brien with her husband and children. O'Brien underwent radio-frequency ablation at Stanford Health Care to treat nodules on her thyroid — a procedure that obviates the need for surgical removal of the gland.
Sarah Laureno

When Sarah O’Brien injured her neck in a car accident in 2012, a doctor examining her medical scans happened to notice that she had nodules on her thyroid, a gland located just below the Adam’s apple on the front of the neck. At the time, she was 24 and had no idea what that even meant.

Over the next eight years, after her neck injury was long forgotten, those nodules grew into a goiter-sized lump that protruded from her neck and caused a range of symptoms, including explosive anger, fatigue, muscle weakness and hot flashes. Medications helped some, but the best available treatment option was the surgical removal of the thyroid, an important gland that secretes hormones controlling the body’s metabolism. She kept putting off the surgery hoping that a better option would emerge. Finally, it did.

Earlier this year, O’Brien became the first patient at Stanford Health Care to undergo a nonsurgical treatment, recently approved by the Food & Drug Administration for benign thyroid nodules, called radio-frequency ablation. 

“It’s definitely helped a lot,” O’Brien said three months after the procedure. “The hot flashes are gone and the goiter on my neck is significantly smaller.”

‘A safe, less invasive way’

The procedure, which has been used for years to treat benign thyroid tumors in Korea, Italy, Brazil and a handful of other countries, involves inserting a thin, needle-like probe through the skin of the neck into the troublesome nodule, said Julia Noel, MD, assistant professor of otolaryngology at Stanford. The probe is activated via a foot pedal, triggering radio waves that send an electrical current through the probe; the heat then destroys tissue of the nodule.

“It’s based on radio-wave technology that has already been used in the U.S. to treat bone, lung, liver and kidney tumors,” Noel said. “It allows us a safe, less invasive way to intervene on a benign thyroid nodule that’s causing problems without the risks of surgery and the need for hormone therapy caused by its removal.”

Thyroid nodules are lumps in or on the thyroid gland. They are relatively common, and, in most cases, their cause is unknown, Noel said. About 50% of people in the U.S. over the age of 60 have at least one nodule. The vast majority of nodules — more than 90% — are benign.

Still, benign nodules can wreak havoc, she said. They need to be watched in case they grow and start pushing on important structures. They can also become unsightly goiters, which are groupings of several nodules that bulge from the neck. Some nodules can become toxic, like O’Brien’s, secreting unwanted hormones that can cause a variety of symptoms, including a racing heart, difficulty sleeping, anxiety and irritability. 

Lisa Orloff, left, and Julia Noel, right, demonstrate how the thyroid is imaged with ultrasound prior to a radio-frequency ablation procedure.
Steve Fisch

“This new treatment is a very good option for people, like Sarah, who have these hormone-secreting nodules called toxic nodules,” Noel said. “It can also prevent cosmetic problems or possible future discomfort.”

‘Hot, hot, hot’

O’Brien said she suffered with symptoms of irritability, hot flashes and anxiety for about a year after the car crash before she finally realized the nodules in her neck were causing these symptoms. 

“I’m usually a bubbly, happy person,” she said. “But the irritability started to interfere with my marriage and my patience with my two kids. And I was hot, hot, hot. To the point where I wanted to scream. So I started going to see doctors.

“They told me they needed to take my thyroid out,” she said. “But I was scared to take out something that should be there.”

For years she prayed for healing, then, last year, she joined a support group on Facebook for people with benign thyroid nodules where she learned about a new procedure called radio-frequency ablation. 

The procedure, which was led by surgeon Lisa Orloff, MD, professor of otolaryngology, with Noel assisting, took less than an hour. There was no overnight stay in the hospital, and she went home to recover that same day.

“I was awake for the whole procedure,” she said. “There was some pressure, but not really any pain.”

O’Brien had two toxic nodules treated out of a total of five benign tumors on her thyroid. The first was fully ablated, and the second reduced in size. Immediately, the size of the goiter on her neck was significantly smaller, she said. Further gradual shrinkage can be expected for up to 12 months from the time of the surgery.

“I could see that notch in my neck,” she said, referring to her Adam’s apple. “I had kind of missed it.”

The other changes came a bit more slowly over the early weeks as she began to heal, she said. First, the hot flashes began to lessen in both intensity and frequency. She found herself wearing blankets at night for the first time in years, even putting on a sweater when she went out for a walk. Also, the overproduction of hormones has begun to level out.

 “There are no more hot flashes,” she said. “I’m still struggling with up and down mood swings, but I’m going on walks every night with my kids, pulling them in a wagon that my aunt bought them. I’m a new mom.”



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