TL;DR: This overview explains the core procedural techniques that enable thyroid radiofrequency ablation (RFA) to be performed safely, precisely, and effectively. It highlights how standardized access, systematic ablation, and active tissue protection work together to optimize outcomes for patients with benign thyroid nodules.
- The trans-isthmic approach provides a stable and controlled access path, allowing continuous ultrasound visualization of the electrode relative to critical neck structures.
- The moving shot technique divides the thyroid nodule into smaller ablation units, ensuring uniform thermal coverage while minimizing excessive heat at the margins.
- Hydrodissection creates a protective safety buffer by injecting a nonionic solution between the thyroid and adjacent structures, insulating non-target tissues from thermal injury.
- Hydrodissection can be dynamically adjusted during the procedure to maintain safe distances as tissue anatomy shifts.
- Together, these techniques support predictable outcomes, enabling meaningful nodule volume reduction while maintaining a strong safety profile.
Achieving optimal outcomes when performing thyroid radiofrequency ablation (RFA) depends on appropriate patient selection and the use of established thyroid RFA techniques. Such techniques maximize ablation efficacy while protecting surrounding structures, allowing clinicians to perform this procedure with precision and safety.
In this blog, we’ll discuss the primary thyroid RFA techniques clinicians rely on in practice, including the moving shot technique and hydrodissection.
Trans-Isthmic Approach
The trans-isthmic approach is the standard access technique used during thyroid RFA. In this method, the electrode is inserted through the thyroid isthmus and advanced laterally into the target nodule under continuous ultrasound guidance. As a result, the practitioner can maintain constant visualization of the electrode tip and its relationship to critical structures.
Furthermore, a trans-isthmic approach stabilizes the electrode within normal thyroid tissue, reducing the risk of unintended movement during the ablation. This makes it a foundational RFA technique.
The Moving Shot Technique
The moving shot technique is the core ablation strategy used to treat thyroid nodules of varying size and shape. Instead of delivering energy from a fixed position, clinicians conceptually divide nodules into several smaller ablation units. The clinician can then sequentially reposition the electrode tip within these zones.
Typically, operators start in the deepest portion of the nodule and move toward more superficial areas. This allows uniform thermal coverage while minimizing excessive heat exposure at the margins.
The Hydrodissection Technique
What is hydrodissection? Simply, it is a technique that physically separates and insulates non-target tissues from thermal injury.
When a thyroid nodule is located near sensitive structures, the thyroid hydrodissection technique is used to create a protective safety margin. During the hydrodissection procedure, a clinician injects a nonionic solution under ultrasound guidance between the thyroid capsule and adjacent structures. The solution does not conduct electrical current, so it confines heat to the ablation zone.
Hydrodissection is not static. It can be adjusted throughout the procedure to maintain a safe distance as tissue shifts during ablation.
Why These Techniques Matter
These techniques enable clinicians to perform thyroid RFA with consistency and predictability. As a result, providers can achieve meaningful nodule volume reduction while maintaining a strong safety profile.
To learn more about thyroid RFA and how to offer patients a minimally invasive, in-office procedure, visit STARmed America’s thyroid RFA resource center.
