Overview

This information is about a procedure called percutaneous ablation. We can do this procedure if you have lumps called nodules on the thyroid (small gland at the bottom of your neck).

Percutaneous means through the skin and ablation means destruction (of tissue). Percutaneous ablation is when we use an electric current to create heat for destroying the nodules.

During the procedure, energy passes through a small needle (probe or electrode). It goes through your skin into the nodules around the thyroid gland. The electric current from the needle heats the nodules to high temperatures, which destroys them.

The aim of this information is to help answer some of your questions about having percutaneous ablation. It explains:

•    the benefits of the procedure
•    the risks of the procedure
•    what you can expect when you come to hospital
•    what happens after the procedure

If you have any more questions or concerns, please contact the interventional radiology (IR) department.

When the procedure is suitable

Percutaneous ablation is a safe and effective way of shrinking thyroid nodules. It is a good option if you are not suitable for high-risk surgery or want to avoid surgery for benign (non-cancerous) lumps.

We might also recommend percutaneous ablation if:

• your nodules are in an area that is difficult to reach
• your nodules are not responding to chemotherapy (a treatment where medicine is used to kill cancer cells)
• you have several small nodules that are too spread out to be removed during surgery
• the nodules put pressure on nearby organs, such as your parathyroid gland (behind the thyroid), wind pipe or voice box
• you have symptoms of an overactive thyroid (hyperthyroid symptoms)
• you want to avoid other treatments like radioactive iodine therapy (a type of internal radiotherapy treatment)

Your doctor may offer you this procedure after you have a detailed medical assessment and tests, including:

• an ultrasound scan
• thyroid function tests (tests to check how well your thyroid works)
• thyroid scans
• fine needle aspiration biopsy (when we use a thin needle to take a tissue sample for testing)

Your doctor talks to you in detail about the procedure, its benefits and risks, and any other treatment options. These options may include surgery and monitoring your condition.

Benefits of the procedure

Percutaneous ablation has various benefits:

• It is less invasive than surgery and does not leave a scar.
• We give you a local anaesthetic medicine for the procedure. This means that you are awake, but do not feel pain and can go home on the same day.
• There is a shorter recovery time than for surgery.
• There is a low risk of complications.
• Your thyroid still works after the procedure and so you do not need thyroid replacement tablets.

Risks of the procedure

All treatments and procedures have some risks of complications. Your doctor talks to you about these risks.

The main risks of percutaneous ablation are:

• bleeding
• a hoarse (rough and harsh) voice because of nerve bruising
• skin burns
• infection

An infection can be a delayed problem and you may have swelling, pain and redness. The redness may be harder to notice on brown and black skin.

Serious complications are rare, but include damage to the:

• food pipe (oesophagus)
• wind pipe (trachea)
• nerves to the voice box (vocal cords)

A permanent injury to the voice box that causes a change in your voice happens in less than 1 out of 100 cases. Sometimes, larger nodules need more than 1 treatment to make them smaller.

Radiation risks

During percutaneous ablation, you are exposed to X-rays. They are a type of radiation called ionising radiation. This may cause cancer many years or decades after you are exposed to it.

You might have some skin redness after the procedure that feels like sunburn. We do not expect this to be permanent. The redness might be harder to notice on brown and black skin.

Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The amount (dose) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.

The IR doctor and radiographer (health professional who specialises in medical imaging) make sure that:

• your radiation dose is kept as low as possible
• the benefits of having X-rays during your procedure are greater than the radiation risks

Radiation and pregnancy

Radiation can be harmful for an unborn baby. If you are or think that you might be pregnant, it is important to tell a member of your medical team before the procedure. We cannot do any procedure that involves radiation if you are pregnant.
 
If you can become pregnant from sex, you need to use protection (contraception) from the first day of your period until your appointment. This means that you will not be pregnant when you have the procedure.

If the first day of your period has already passed, please contact the interventional radiology (IR) department. We can then give you another appointment within the first 10 days of your period. 

We ask you to sign a pregnancy declaration form before the procedure.

Other treatment options

The other treatment options to percutaneous ablation are:

• surgery, such as a thyroid lobectomy (a procedure to remove half of the thyroid gland from the neck)
• close monitoring of the thyroid nodule if you do not have any concerning or troublesome symptoms