• This is a minimally invasive procedure with little to no scarring. • The procedure lasts 15 - 60 minutes. • Since healthy tissue is not destroyed during this procedure, the use of thyroid medications is not expected afterwards. • The procedure is highly effective. The reduction in size for a nodule is typically between 60-90% after one year.

• Patients with benign thyroid nodules causing symptoms • Patients who cannot or choose not to undergo surgery. • Patients with rapidly growing thyroid nodules or cysts that are benign • Nodules that produce excess thyroid hormone when radioactive iodine treatment is not preferred. • Visually disturbing thyroid nodules • Any nodule considered for RFA must be confirmed by biopsy to be benign.

• Someone who has undergone prior surgery, radiation, or sclerosing (scar forming) therapy to the thyroid or thyroid area of the neck as this causes altered anatomy increasing the risk of damage to non-thyroid tissue. • Individuals with implantable pacemakers or defibrillators. • Individuals with extremely small thyroid nodules. • Individuals who have sonographic features of their nodules that are suspicious for cancer unless additional studies have been performed to verify benign status of the nodule. • Individuals who have had previous damage to their vocal cord. • Pregnant patients. • Patients with severe heart disease. • Patients taking chronic anticoagulants or blood thinners that can not briefly discontinue these medications for the procedure.

When thyroid tissue is exposed to temperatures in excess of 64 degrees celsius, it is permanently destroyed. This is very similar to boiling an egg. The special defense cells of the body break down the dead nodule tissue, which leads to the shrinking of the nodules. Typically, we see 40-60% after 3 months and around 60-90% after 1 year. Residual connective tissue is the only remnant of the former nodule. Any surrounding healthy tissue remains untouched and will continue to produce hormones. This means that daily intake of tablets is not necessary following the procedure.

• RFA requires local rather than general anesthesia and is relatively painless. RFA does not affect energy levels and allows the patient to resume most normal activities within a day of the procedure. • Fewer complications • Preservation of thyroid function so that thyroid hormone replacement is not necessary

One treatment will sufficiently decrease the average size nodule. Repeated procedures may be necessary for very large nodules or nodules close to vocal cord nerves.

• The procedure is typically performed in our office in an exam room. Using ultrasound guidance, the doctor inserts a probe into the thyroid nodule. The probe generates radio frequency energy which destroys the nodule. The body then breaks down the treated tissue. • The procedure itself takes between 15 to 60 minutes depending on the number or volume of nodules. • We recommend that our patients set aside approximately 3 hours on the day of the treatment.

• The procedure is so gentle that most people have little to no discomfort. The thyroid gland itself is not sensitive to pain, and the skin and surrounding area of the thyroid gland are anesthetized for the procedure. Only 2-3 % of patients experience discomfort. This is usually a temporary burning sensation similar to that experienced during dental procedures. In the event of severe discomfort the procedure will be interrupted and anesthetic will be injected again until there is no pain. • The patient will be able to breathe and talk the entire time and will be able to converse with the doctor during the procedure. • Two grounding pads will be attached to the thighs. • The patient will be covered with sterile cloths and antiseptic will be applied to the neck. The patient’s head will rest on a small cushion. • The doctor will use a very thin needle to place a local anesthetic under the skin in the area surrounding the thyroid gland. • Although very rare, an inpatient stay or follow-up treatment may become necessary if a complication presents during or after the procedure.

• The patient will be monitored for about 30 minutes after the procedure and discharged with any necessary prescriptions. • After the treatment, a chilled bag is placed on the treated area with light pressure • Certain activities will need to be limited for three days following the procedure which include: • Lifting objects over 10 lbs. • Strenuous physical activities • Activities that involve holding ones breath such as playing a wind instrument or inflating objects. • Singing, shouting or over stressing the voice.

Studies done in Asia and Europe have typically shown at least a 50 percent reduction in nodule size over 6-12 months after undergoing the procedure. Clinical trials have shown that non- functioning benign nodules shrank by 51-85 % within six months. In most patients, nodule related symptoms significantly improved or disappeared. In a long term follow up study, nodules consistently decreased by 93 %.

• A study of approximately 1500 patients showed an overall complication rate of 3.3%. The major complication rate was 1.4% • Complications include: • Temporary hoarseness • Wound infections • Vomiting, cough or seared skin at puncture site • Patients with hyperthyroidism may rarely develop hypothyroidism requiring thyroid hormone replacement

At this time, most insurance companies do not cover the cost of the RFA procedure. This would be an out-of-pocket expense for the patient. Please contact our office to schedule a consultation with Dr. Leffert and learn more about the costs associated with this procedure.