Benign (non-cancerous) thyroid nodules are common and usually do not require treatment.  If they are causing symptoms, such as pain or pressure, or cosmetic issues, the following are less invasive treatment options (less pain and scarring) that may offer an alternative to surgery and radioiodine therapy (RAI). You would need a referral letter from your own NHS doctor to be considered by the settings listed below.

Ethanol ablation  

This is used as a non-surgical treatment usually for cystic (i.e. pure cyst) or predominantly cystic benign thyroid nodules.  This involves draining the cyst of fluid under ultrasound guidance then injecting ethanol immediately back into it.  It causes the walls of the cyst to stick together and it stops the cyst from recurring. It can be quite effective in shrinking large cysts. 

Patients who may be suitable for ethanol ablation would typically have symptoms (normally a feeling of compression), a cyst of 2cm or greater which is macrocystic (this means the cyst should really be in one or possibly two parts). Other cysts can have a honeycomb-like structure which makes them impossible to drain.  

It is also sometimes used in patients with recurrent thyroid cancer in the neck and lymph glands. This involves injecting ethanol in the lymph gland with the cancer cells and, in theory, the ethanol destroys them. However, the quality of studies is variable, so most doctors would say definitive treatment for lymph glands with thyroid cancer cells usually requires an operation. 

Ethanol ablation for benign thyroid nodules is performed by interventional radiologists, and sometimes by surgeons, and is available in some NHS centres across the UK, including Manchester Royal Infirmary, The Royal Berkshire Hospital, Reading, The Royal United Hospital, Bath, Birmingham, Edinburgh and Newcastle. 

Thermal ablation

Percutaneous Radiofrequency Ablation (RFA) for the treatment of benign thyroid nodules 

In this procedure, a thin electrode or needle is inserted into the nodule under local anaesthetic. Ultrasound is used to guide it into position. The needle sends out an alternating current at the frequency of radio waves that heats the nodule to destroy it. This is known as ablation. The aim is to shrink the nodule to relieve symptoms and improve appearance. RFA can be used where the nodule is solid, with some cystic components. Not all nodules are suitable for RFA treatment. This depends on many factors including size, location, the appearance of nodules, and the symptoms being treated. Careful assessment is required as some nodules are adjacent to the carotid artery or laryngeal nerve and there is a very small risk of stroke or damage to the voice box.  

There is only a limited number of centres that routinely do radiofrequency ablation. However, a trial has now started in certain centres across the UK where patients with benign thyroid nodules are randomly assigned either thyroid surgery or RFA. The nodules must be causing compressive or cosmetic symptoms and not have changed thyroid function (non-toxic).

Read about the clinical trial

We understand that RFA is currently offered at the following NHS hospitals.

Prospective patients and/or their doctors should contact the hospitals directly to check the services they offer before asking for a referral:

Buckinghamshire Healthcare NHS Trust Hospital 

Cambridge University Hospitals NHS Foundation Trust

East and North Hertfordshire Teaching NHS Trust

Freeman Hospital, Newcastle on 0191 213 7625

Guys Hospital, London

Hammersmith Hospital, London

Imperial College Healthcare NHS Trust

Ipswich General Hospital, Dr Musaad Quarash, interventional radiologist [email protected]   cannot take referrals from outside the area.

Lister Hospital, Stevenage

Medway Hospital, Kent, 01634 833950

Milton Keynes Hospital

Royal Berkshire Hospital, Reading. Due to high demand, this hospital can no longer take referrals from outside the area. 

Royal Bournemouth Hospital, Bournemouth

Royal Infirmary, Leicester - cannot take referrals from outside the area

Queen Elizabeth Hospital, Birmingham

Coming soon:

Brigend, Dundee, High Wycombe, Royal London, Taunton, Worcester

NICE guidance on RFA 

Read about a new trial for RFA

Read Gill's story

Ultrasound-guided Percutaneous Microwave Ablation for the treatment of benign thyroid nodules 

In this procedure, a thin wire is inserted into the nodule under local anaesthetic. Ultrasound is used to guide it into position. It sends out microwaves that heat the nodule to destroy it (ablation). The aim is to shrink the nodule to relieve symptoms and improve appearance.

Some nodules are better suited to microwave ablation than others, this depends on many factors including size, location, the appearance of nodules, and the symptoms being treated. Careful assessment is required as some nodules are adjacent to the carotid artery or laryngeal nerve and there is a very small risk of stroke or damage to the voice box

This procedure is now approved by the National Institute for Health and Care Excellence (NICE). It is still a very new technique and is currently being performed by interventional radiology departments.

We understand that it is currently being offered in the following hospitals.

Prospective patients and/or their doctors should contact the hospitals directly to check the services they offer before asking for a referral.

East Surrey Hospital, Surrey

Princess Royal University Hospital, Kent  01689 863000  ask for the interventional radiology department.

Queen Alexandra Hospital, Portsmouth, consultant interventional radiologist [email protected]

Royal United Hospital, Bath

Read more about microwave ablation 

Read Sandra's story

Read Bridget's story

Thyroid Artery Embolization (TAE)

This minimally invasive technique to treat benign thyroid nodules is performed through a small incision in the groin or wrist. The blood vessels to the thyroid gland are blocked to shrink the thyroid nodules. 

This technique is not currently available in the UK; however, researchers at the Royal Berkshire NHS Foundation Trust are looking to investigate this novel treatment as an option for suitable patients. 

Watch our webinar on non-surgical treatments for thyroid nodules

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