Thyroid Ablation: The Basics

Thyroid ablation refers to a range of non-surgical, minimally invasive techniques for thyroid nodule treatment. These techniques can be used instead of surgery to treat thyroid nodules and cysts. Generally, nodules and cysts must have had two benign biopsies to be eligible for ablation however some small thyroid cancers may also be eligible for these techniques.  In additional, small ‘indeterminate’ nodules may be eligible on a case by case basis. There are two main forms of thyroid ablation: chemical ablation and thermal ablation.

 

A/Prof Sinclair performed and set up the first thyroid radiofrequency ablation program at Mount Sinai Hospital in New York in 2019.  In 2021, she moved to Australia and performed the first radiofrequency ablation in Australia in April of that year. She has since performed hundreds of ablation on patients from around Australia and internationally with excellent results and minimal complications. She is the only expert on thyroid ablation in Australia at the current time (start of 2025) and performs multiple procedures weekly. She frequently lectures on this topic nationally and internationally and ran the first ablation course in Australia in November 2024.

Chemical Ablation

  • The most widely used thyroid chemical ablation technique is ethanol
  • Ethanol ablation is predominantly effective for thyroid cysts. Thyroid cysts are thyroid masses that are mainly comprised of fluid over solid tissue (whereas nodules contain more solid tissue than fluid although both components can be present)
  • Simple removal of fluid from thyroid cysts using a thin needle (‘aspiration’) in the office rarely cures the problem and the cyst usually comes back. However, aspiration is the first line treatment for thyroid cysts as some cysts may respond to this alone.
  • In ethanol ablation, the fluid is initially aspirated with a needle and the cyst cavity may be washed out with saline (sterile salt water). Pure ethanol is then injected into the cyst using the same needle and left within the cyst, Occasionally the ethanol may be withdrawn out of the cyst after sitting for approximately 10 minutes to facilitate adequate ablation.
  • Ethanol causes cell death and scarring which, in approximately 80% of cases, prevents the cyst from recurring.
  • The image below shows a symptomatic right thyroid cyst. The video shows ethanol being instilled into the collapsed cyst after its internal fluid has been removed.

Thermal Ablation

  • Thermal ablation techniques use heat (of varying forms) to cause cell death and scarring.
  • A/Prof Sinclair is an expert in thyroid thermal (and chemical) ablation and is the only practitioner with extensive experience in these techniques at the current time in Australia (as of January 2025)
  • Thermal ablation techniques include radiofrequency ablation, laser ablation, microwave ablation and high intensity focused ultrasound ablation.
  • Radiofrequency ablation (RFA) is likely the most effective of the thermal ablation techniques and is the one most commonly performed by A/Prof Sinclair
  • RFA is performed as an outpatient under local anesthesia. A slender, specially designed, internally cooled electrode is introduced through the skin and guided (using ultrasound) into the target thyroid lesion. The energy is delivered to multiple areas within the nodule to obtain a homogeneous ablation. Dr Sinclair will explain the technique in greater detail when you meet with her.
  • The ablation takes anywhere from 15-60 minutes depending on the size and consistency of the thyroid lesion.
  • The nodule does not shrink immediately but will shrink over the subsequent 6-12 months following ablation. Initially the nodule can actually be a little more prominent for 7-14 days until the inflammation settles.
  • The videos below show nodules undergoing ablation.
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