Thyroid RFA is performed as a day case procedure, so patients are admitted for treatment and discharged on the same day.
Normally the procedure is performed under local anaesthetic only. In this case patients should stay well hydrated and may have a light meal beforehand. A very heavy or fatty meal immediately before the procedure should, however, be avoided. If the procedure is being performed under mild sedation patients are advised to not eat food for six hours before the procedure and have only clear fluid up to four hours before. Patients should still take their normal medications with a sip of water on the day unless advised not to.
On arrival patients undergo a routine admission check which includes recording blood pressure, pulse and oxygen saturation and changing in to a hospital gown. The doctor performing the procedure will undertake written consent and this is an opportunity to ask any further questions. A cannula (tube) is often inserted in to an arm vein as a simple precaution and can be used after the procedure to give paracetamol.
The procedure is performed in a treatment room. Small nodules might take as little as 20 to 30 minutes to treat but larger nodules can take up to an hour. As well as a doctor there will be a healthcare assistant and nurse looking after the patient. Thyroid RFA is performed with the patient lying down with the neck slightly extended. The neck is sterilised with cleaning fluid and the area is draped to ensure sterility. Local anaesthetic is given with a very fine needle and additional fluid is injected under the skin and over the thyroid gland to provide protection to surrounding structures.
The treatment needle is inserted without making an incision. Normally only a single point of access is required but sometimes a couple of different access points will be needed. During the procedure the patient can expect to hear the gurgling sound of a water pump in the background (this cools the needle during treatment). Patients are encouraged to swallow and breath normally during the procedure and the doctor and team will make frequent checks with the patient to ensure they are comfortable. Music can often be quite relaxing and calming during the procedure. While the treatment is being performed the patient may experience a painless crackling and popping sound and sensation in the neck which is related to tissue heating and steam formation. This is normal and a reassuring sign of effective treatment. The electrical energy delivered to the nodule can sometimes also cause discomfort or referred pain to the shoulder, neck, jaw or towards the ears. There are several ways this can be managed during the procedure to ensure discomfort is minimised.
