The Efficacy and Safety of Thyroid RFA: The Latest Updates

Hendra ZufryIndonesia Speaker The Efficacy and Safety of Thyroid RFA: The Latest UpdatesRadiofrequency ablation (RFA) of the thyroid has emerged as a minimally invasive alternative to surgery for benign cystic and solid nodules, low risk papillary thyroid microcarcinoma (PTMC), and recurrent thyroid cancer. Standardized training and international guidelines have facilitated its global adoption. Long term efficacy and safety data position thyroid RFA as a primary treatment compared with other thermal techniques. In recurrent thyroid cysts, RFA achieves a mean volume reduction ratio (VRR) of 87 ± 11.6 % after one session, outperforming ethanol ablation. For benign solid nodules, a single treatment yields 98.8 % VRR at ten year follow up. Larger nodules (> 20 mL) or multinodular goiters often require multiple sessions to optimize shrinkage, cosmesis, and symptom relief. Autonomous thyroid nodules (ATNs) under 30 mL demonstrate rapid VRR and early TSH normalization, while larger ATNs reach approximately 70 % VRR by six months, correlating with euthyroidism. In indeterminate Bethesda III nodules with low suspicion ultrasound features, RFA delivers 87.4 % VRR at one year in surgery averse patients; Bethesda IV lesions achieve 94.9 ± 6.1 % VRR. In low risk PTMC, RFA produces 100 % VRR without disrupting thyroid function over two years, offering an alternative to active surveillance. Early stage papillary thyroid cancers (T1a/T1b) show 99.31 % VRR at 48 months, with higher disappearance rates in T1a. In recurrent papillary carcinoma, RFA attains 100 % VRR and comparable disease free survival to reoperation, with fewer complications. A case of recurrent cervical medullary carcinoma reported 68.6 % VRR at six months. Complication rates are low. Pre procedural risks include lidocaine toxicity; intra procedural events comprise pain, hematoma, burns, and transient voice changes; post procedural issues may involve mild thyroid dysfunction, discomfort, or rare nodule rupture. These events are generally mild and non–life threatening. Optimal outcomes depend on meticulous patient preparation, advanced electrode design, precise anatomic knowledge, judicious anesthesia, and high operator proficiency in basic and advanced RFA techniques. Patient satisfaction scores are consistently high, reflecting improved quality of life and favorable aesthetic outcomes. Key Word : Thyroid RFA, Efficacy, Safety Profile, Long term Data.