Summary: Radiofrequency ablation (RFA) offers a safe, effective treatment for benign thyroid nodules. While the side effects of RFA are generally mild, clear patient communication is essential. This blog outlines key thyroid RFA side effects and provides strategies for counseling patients with confidence.
- RFA has a low complication rate (2–4%), with permanent issues extremely rare.
- Common side effects include mild pain, swelling, bruising, and hoarseness.
- Serious side effects like nerve injury or hypothyroidism are rare but should be discussed.
- Counseling tips: Set expectations early, use clear language, provide context with statistics, compare with surgery, and outline care plans.
Radiofrequency ablation (RFA) of benign thyroid nodules has emerged as an effective, minimally invasive treatment option. Patients and physicians alike appreciate the procedure’s favorable safety profile. Compared to surgery, radiofrequency ablation side effects are uncommon and usually mild. However, careful patient communication about complications is crucial to building and maintaining a strong patient-clinician relationship.
In this blog, we’ll share the most current findings on RFA side effects. We’ll also offer practical advice to help communicate thyroid ablation side effects with patients in a reassuring manner.
Continue reading to learn how to best advise patients who undergo the procedure to help manage their expectations.
RFA Safety Profile: Low Overall Risk and Thyroid Preservation
One reason thyroid RFA is growing in popularity is that overall complication rates for the procedure are notably low. Large studies report an overall complication rate on the order of 2% to 4%. Major complication rates are well under 2%. Even major complications tend to be transient, and most resolve without lasting injury.
Crucially, to date, no RFA-related deaths have been reported in the literature.
Furthermore, studies show that patients undergoing RFA have lower rates of complications compared to thyroidectomy. For example, one comparative study found temporary RLN paresis in 2.7% of RFA patients versus 8% of surgical patients.
Likewise, RFA avoids the risk of hypoparathyroidism, which is present in ~5% of surgical thyroidectomy cases. That’s because it preserves the thyroid gland, as well as thyroid function.
In long-term follow-up, the incidence of new permanent hypothyroidism after RFA is around 0.07%, essentially near-zero. By contrast, surgical lobectomy can lead to hypothyroidism in 20% to 30% of patients.
Overall, thyroid RFA side effects are generally minimal and manageable.
Common Side Effects of RFA for the Thyroid
Patients should be informed about the most common, minor side effects of RFA. Most of these complications are transient. They frequently resolve with little or no intervention.
The most common, minor thyroid RFA side effects include:
- Mild to moderate pain at the treatment site
- Mild swelling
- A feeling of fullness at the probe insertion site due to edema
- Temporary bruising or neck discoloration at the needle site
- Minor bleeding at the probe insertion site
- Minor bleeding within the thyroid nodule
- Transient cough
- Sore throat or mild hoarseness
- Nausea, lightheadedness, or a vasovagal response
- A mild, low-grade fever (usually <38°C/<100.4°F)
- First-degree skin burns/blisters at the needle insertion point
Many of these minor side effects can be managed with simple measures at home, such as ice packs and Tylenol. When reviewing these common effects, stress their short duration and conservative management. However, always encourage patients to reach out if something feels more intense than expected.
Rare but Serious Thyroid Ablation Side Effects and Complications
Serious complications from thyroid RFA are uncommon. Even so, physicians should still discuss them as part of informed consent.
The most relevant rare radiofrequency ablation thyroid nodule side effects to know are:
- Recurrent laryngeal nerve injury
- Thyroid nodule rupture
- Horner’s syndrome
- Radiating arm pain or weakness
- Permanent hypothyroidism
Serious complications like permanent voice change or significant bleeding happen only in a tiny fraction of thyroid RFA cases.
Tips for Communicating RFA Side Effects to Patients
Here are some practical strategies for physicians to ensure patients are well-informed about thyroid RFA side effects.
Be Transparent and Set Expectations Early
Begin the discussion by acknowledging that no procedure, including RFA, is 100% free of side effects. We recommend discussing the common, minor side effects first to best set expectations.
It’s also important to mention the timeline of thyroid nodule reduction. Patients should know that the nodule will shrink gradually over weeks to months. Inform them that it might swell slightly before it starts shrinking. This can help preempt patient anxiety.
Use Clear, Non-Alarming Language
When speaking to patients, choose language that is clear and non-alarming for a non-specialist audience. For example, instead of saying “transient paresis of the recurrent laryngeal nerve,” you might say “temporary hoarseness”.
Also, we’ve found it’s helpful to use analogies. For pain, you could liken it to the soreness after a shot or a dental procedure. For swelling, compare it to a “bruised feeling.”
Quantify Risks with Context
Whenever possible, give patients a sense of the numbers. Saying a side effect is rare is less effective than saying that it occurs in about 1 out of 1000 patients. Concrete statistics help patients gauge risk for themselves and find it more credible
Emphasize RFA’s Safety vs Alternatives
Many patients considering RFA have also been recommended surgery or radioactive iodine. It can be helpful to contrast RFA side effects with those of other treatments. Providing this context educates the patient on why RFA is a good option while framing the side effects in a positive light.
Still, always be careful not to oversell. Aim to leave the patient feeling they’ve chosen a safe and advanced treatment.
Describe Management and Contingency Plans
Reassure patients that if a side effect does occur, it will be recognized and managed quickly. For each of the main complications you mention, briefly note how you’ll handle it. When patients hear there’s a plan, it helps reduce their fear of the unknown.
Also, instruct patients on self-care and signs to watch. Provide written instructions that cover expected symptoms and red flags. For example, tell them how to manage mild pain at home, but also what level of pain should prompt a phone call.
Document the Discussion
A well-documented and thorough side-effect discussion both protects you and empowers the patient. You might even provide the patient with a handout or link to reputable resources. That can help them absorb the information at their own pace and solidify understanding.
Explore RFA Patient Experiences with STARmed
Radiofrequency ablation has expanded our ability to treat thyroid nodules effectively with minimal side effects. Are you seeking more resources to help you advise patients who are new to the procedure? View our video library and explore our patient success stories to help enhance your patient communication.
