Thyroid nodules

Dr Marios Agathangelou performs thyroid nodule radiofrequency ablation (RFA) in Nicosia and Limassol, Cyprus — covered by GESY, €0 for GESY beneficiaries. Radiofrequency ablation (RFA) treats benign thyroid nodules with a fine probe placed through the skin under continuous ultrasound guidance. The probe warms the nodule from within, section by section, while the surrounding gland stays untouched.

Over the following weeks and months the treated tissue is absorbed by the body: the nodule shrinks, pressure and swallowing discomfort ease, and the visible bulge recedes — with thyroid hormone function typically preserved.

No surgical scar Local anaesthesia Same-day discharge Thyroid function preserved

The procedure is fully covered by GESY. It is done as an inpatient admission, and that admission includes the treatment — you pay nothing for the procedure.

Separately, the outpatient visit — the initial assessment, where it is decided whether the treatment suits you — may carry a small co-payment, usually €0–10, as any specialist visit within GESY does.

The co-payment is per activity, and it stops once your total co-payments for the year reach €150 — past that you pay nothing. Some categories of beneficiary have different limits.

Both need a valid referral, from your personal doctor or from a specialist.

Outside GESY, or with private insurance? We provide the documentation your insurer asks for, and a clear cost estimate at your consultation, before you decide anything.

Before any treatment is discussed, the nodule must be shown to be benign. International guidance recommends two separate fine-needle aspirations (FNA) returning benign results before ablation. This is not paperwork: ablation treats benign nodules, and where malignancy is suspected the right answer is a different one.

A benign nodule that troubles you with nothing is not a problem, and needs no operation. Most stay much as they are.

How often does one grow? Seldom enough to wait. In an Italian study that followed 992 people with benign nodules for five years, the nodule grew in about 1 person in 6.

When a nodule does grow, it grows slowly: among those that did, the largest measurement went from about 13 to about 18 millimetres over the five years.

The question people carry is whether it is cancer. Fortunately, the answer is reassuring. Of 1,567 nodules followed, five turned out to be cancer — about 1 in 300.

What decides treatment is not the size but what the nodule causes you — pressure, difficulty swallowing, a visible bulge — and whether it is growing. Both are what the follow-up scan is for.

In your own time. We will go through it together as often as you need, and move when you are ready.

It is not done in pregnancy, where malignancy is suspected, where there is pre-existing vocal cord palsy, or where the nodule touches the trachea, oesophagus or carotid artery. Previous radiation to the neck is also a reason for caution. And something rarely said: a nodule that does not trouble you and is not growing usually needs no treatment at all.

One year after the ablation the nodule's volume usually falls by two thirds to three quarters, pressure symptoms ease, and thyroid function is generally preserved. Serious complications are uncommon.

The other side: a proportion of nodules regrow over time, and a small share of patients need a second session or eventually surgery. Large nodules are rarely treated completely in a single session.

Most people have no trouble at all. Warmth or pressure in the neck during the treatment, mild tenderness for a few days and sometimes a small bruise are common, and settle on their own.

The serious risk worth knowing about is the voice. It is rare. In a Korean record of 1,459 patients treated at 13 centres, 15 had a change in voice — about 1 in 100 — and in that record every one of them recovered on its own.

The risk is not the same for every nodule. The nerve that works the vocal cords runs just behind the thyroid, so a nodule sitting against it is treated differently, or not at all. Where it sits is checked on ultrasound before the ablation, and in some cases that changes the plan.

Less often, and less seriously: a bruise in the neck, nausea, a small skin burn. In that same record one patient in the 1,459 was left with an underactive thyroid needing daily hormone.

Occasionally a nodule cannot be treated whole in one sitting — a large one especially — and the rest is left for a second session. That is not a complication — it is part of the treatment plan.

The most important difference from surgery is not a complication — it is that the nodule can come back. In a five-year Italian follow-up about 1 nodule in 5 regrew, and about 1 in 8 was treated a second time. It is not a dead end: ablation can be repeated, and surgery remains open afterwards.

Bear in mind that the diagnosis rests on the biopsies taken beforehand — which is why two of them are asked for, and why a suspicious nodule belongs on a different path.

Your follow-up here runs at one, three, six and twelve months, each visit with an ultrasound. We measure the volume of the nodule and record what you feel in your neck — though the shrinking and the easing of symptoms do not have to move in step.

We will go through all of it before you decide.

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