A woman in her early 30s left a Taipei hospital with nothing but a tiny puncture wound on her neck. Six months later, the massive thyroid nodule that had made it painful to turn her head and swallow was almost entirely gone.
The case, treated at Taipei City Hospital Wanfang Branch, highlights the growing clinical application of radiofrequency ablation (RFA) for benign thyroid nodules — a minimally invasive outpatient procedure that leaves no visible scar and allows patients to return to work the following day.
When Benign Doesn't Mean Harmless
The patient, an office worker, first sought medical help after noticing a lump on the left side of her neck. Turning her head had become uncomfortable, and swallowing was increasingly difficult. Imaging revealed an 8-centimeter nodule on her left thyroid gland — unusually large, though two separate fine-needle aspiration cytology tests confirmed the mass was benign.
A benign result, however, did not resolve the problem. The nodule's size had already begun pressing on surrounding tissue, and the patient was weeks away from relocating abroad for work. She needed a solution that would address her symptoms quickly, preserve her appearance, and require minimal recovery time. Traditional thyroid surgery — with its visible neck incision, risk of complications including recurrent laryngeal nerve injury, and a multi-week recovery — was not an option she was willing to accept.
Wanfang Team Opts For Outpatient RFA
After a thorough evaluation, Dr. Ding Yi-fang, an otolaryngologist at Wanfang Branch, recommended radiofrequency ablation. The procedure was performed under sedation, with a thin electrode needle inserted under ultrasound guidance to deliver targeted heat that ablates the nodule from within. The session lasted between 30 and 60 minutes. The patient was monitored for approximately two hours and discharged the same day, returning to her regular work schedule the following morning.
"Even when a nodule is confirmed benign, we cannot base our treatment decision on that word alone," Dr. Ding said. "We assess the nodule's size, ultrasound characteristics, fine-needle aspiration results, and the patient's clinical symptoms as a whole."
Small, asymptomatic nodules can be monitored with ultrasound every six to 12 months, Dr. Ding explained. But when a nodule causes difficulty swallowing, shortness of breath, a persistent foreign-body sensation in the throat, hoarseness, or a visible protrusion in the neck, treatment becomes necessary.
Nodule Shrinks More Than 90% Over Six Months
Progress was swift. Within one week of the procedure, the patient's swallowing discomfort had eased noticeably. By the three-month follow-up, nodule volume had decreased by approximately 60%. At six months, the reduction exceeded 90%, and the visible neck bulge had disappeared entirely. Blood tests confirmed that thyroid function had been preserved: levels of thyroid-stimulating hormone (TSH) and free thyroxine (Free T4) both remained within the normal range.
Dr. Ding cautioned that RFA is not appropriate for every patient. Candidates must first undergo ultrasound imaging and fine-needle biopsy to rule out malignancy. Nodules confirmed or strongly suspected to be malignant, those extending behind the sternum, or cases involving severe tracheal compression may still require conventional surgery.
Anyone who notices a neck lump, experiences persistent hoarseness, difficulty swallowing or breathing obstruction, or sees a lump growing rapidly should seek medical evaluation promptly to determine the nodule's nature and the most appropriate course of treatment.
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