Graves’  disease is an autoimmune disorder in which your immune system attacks your thyroid gland, causing damage to your thyroid cells. Graves’ disease is also known as Toxic Goiter. Naturally, our body forms antibodies to fight viruses or other microorganisms to help our body to get rid of the infection. In Graves’, your body forms self-attacking antibodies that destroy your thyroid  (Confused Antibodies).  


The inflammation caused by Graves’  autoantibodies wax and wane but every time it affects a part of your thyroid gland. Over the course of the years, your gland becomes diffusely involved or you may develop a Toxic / Hot nodule. The end result is your gland will be overactive (hyperthyroidism).  


Doctors do not know what causes your immune system to attack your thyroid gland.  The medical literature refers to a combination of factors, including heredity, sex, age, stressful life events that may determine your likelihood of developing the disorder. 

Graves’ is most common in middle-aged women and sometimes it runs in families.  


There is no known way to prevent this disorder. But on the bright side, this disorder is very treatable and now you can get the treatment of Graves’ disease without facing the risks of surgery, through performing radiofrequency ablation of the thyroid gland.

Symptoms of-graves disease patient needs for treatment

How would you know you need a Graves’ disease treatment?

Signs and Symptoms:  Some patients with Graves’ thyroiditis may have no symptoms.  However, the common symptoms are anxiety, irritability, sleep irritability, unintentional weight loss, hand tremors, heart palpitation or racing depression, sensitivity to heat, forgetfulness, muscle weakness, puffy bulging eyes, wet moist skin, diarrhea, and menstrual irregularities. 

Some patients got enlargement of the thyroid gland or have nodules, called Goiter. This category feels something stuck in their throat or discomfort during swallowing or breathing 

Tests for Graves’ treatment

  • Diagnosis of Graves disease is based on your signs and symptoms and thyroid blood tests especially TSH, T4, T3, and auto-antibodies levels.
  • Radioactive thyroid uptake scan sometimes needed by your physician to evaluate how the thyroid is functioning. It also evaluates the presence of any toxic nodule.
  • Ultrasound scan is very important to determine if your gland is enlarged or if you have any suspicious nodules.


If you have any of these symptoms or feel that you are developing thyroid issues please consult with your primary care doctor. In some cases, your doctor may refer you to a specialist called an endocrinologist.

What are the complications of Graves’ disease?

Graves’ disease complications can include:

  • Heart arrhythmia can lead to heart failure.
  • Thyroid storm/thyrotoxic crisis. It happens when severe hyperthyroidism is untreated or mistreated. A thyroid storm is a medical emergency and can require hospitalization.
  • Graves’ ophthalmopathy occurs as a result of auto-antibodies attacking muscles and other tissues around the eyes. The result is inflammation and tissue buildup behind the eye, causing the eyeballs to bulge (proptosis). 

Graves in pregnancy can cause a lot of problems such as miscarriage, fetal thyroid dysfunction, poor fetal growth, maternal heart failure, and preeclampsia.

What are your options for Graves’ disease treatment!

The goal for treating Graves’ disease is to alleviate your symptomology by stopping the extra production of thyroid hormones and to block its effect on your different body systems. 

Some treatments options that your physician or endocrinologist can recommend for you  include:

  • Radioactive iodine therapy (RAI)
  • Anti-thyroid medications
  • Beta-blockers
  • Surgery
  • Radiofrequency thyroid ablation 

What are the drawbacks of treating Graves’ disease with surgery?

Surgery in Graves is very limited and is reserved when RAI or conservative treatment is ineffective. It is recommended when the patient has a large disfiguring nodule, AFTN nodule or there is a suspicious or malignant nodule by FNA biopsy.  

Surgery will require removing half of the whole thyroid gland. Therefore you will lose at least part of your thyroid gland. It is only done under general anesthesia and requires at least one night stay at the hospital.

There is a longer recovery time following surgery. You will have a postoperative neck scar.  In addition to the risk of associated general anesthesia.

Also, there is a risk of potential damage to the vocal cord nerve that controls your voice.

Accidental removal of the parathyroid glands is also a known risk associated with thyroidectomy.

Can Graves’ Disease be treated without surgery?

Graves’ treatment most of the time can be achieved by antithyroid medications and Radioactive Iodine therapy. But if the symptoms continue to worsen or become uncontrolled despite treatment, or the patient prefers or can not tolerate radioactive agents or medications, now there is a need to look for alternatives.

Radiofrequency thyroid ablation ( RFA) can be effective if Graves’ patient develops a large, unsightly neck nodule or toxic nodule. RFA is very beneficial in treating Autonomously Functioning Thyroid Nodules (AFTN) and can become also curative. It is a second-line option for AFTN treatment in case of medical contraindications or patient unwillingness to undergo surgery or radioactive iodine therapy. RFA is a less invasive option  than surgery and with no systemic side effects  like the ones associated with  radioactive iodine treatment

Benefits of choosing radiofrequency ablation for Graves’ disease treatment over surgery?

Thyroid Radiofrequency Ablation (RFA) is a very safe procedure with minimal risk. The whole RFA procedure is done through a small puncture into your neck. No postoperative scar or suture. 

  • It is an outpatient procedure that typically takes 30-45 minutes depending on the nodule size.
  • It is performed under local anesthesia so you can avoid all complications related to general anesthesia 
  • No downtime you can resume your normal activity the day after yours.
  • RFA literature shows that RFA can normalize thyroid function in 45–50% of medium size AFTN and in more than 80% of small size AFTN.  

Learn more about non surgical alternative for treating enlarged thyroid by performing Radiofrequency ablation treatment 

About the possible side effects of using radiofrequency ablation for Graves’ disease treatment

As with any medical procedure, there is some inherited risk however RFA has a very low complication rate and much lower side effects compared to surgery. Some reported risk is:

  • Temporary hoarseness
  • Minor skin bruise
  • Burn at the needle entry site
  • Minimal bleeding
  • Nodule rupture

How long does it take to recover from radiofrequency ablation treatment of Graves’ disease?

The RFA procedure is approximately 30-45 minutes long, depending on your nodule size. It is done at our center as an office-based procedure under local anesthesia. You can go to work or resume your normal activity the next day.

About our approach to Graves’ disease treatment

Prior to your RFA, you will have a consultation appointment with Dr. Elshenawy. 

She will perform an office ultrasound scan of your nodule and review your fine needle biopsy result.  She will determine if another FNA prior to RFA is required or not. 

She will explain in detail the RFA procedure, benefits, risks, possible outcomes, and alternative options. Limited blood work panel for thyroid functions and coagulation factors before RFA will be required. You will have time to ask all your questions and address your inquiries. 

On your RFA day, you will come to our center to fill all paperwork needed.

  • You will change your clothes into disposable gowns. No jewelry, body piercing, or metalware can be worn.
  • The patient is able to breathe and talk the entire time. you will be able to converse with the doctor during the procedure.
  • Two grounding pads will be attached to anterior thighs.
  •  Your neck will be cleaned with a skin antiseptic. Then under sterile conditions marks will be placed on your skin to demarcate parts of the nodule. The patient’s head will rest on a small cushion and their eyes will be covered with a mask.
  • Your heart rate, blood pressure, and voice are monitored during the entire RFA. 
  • First, your doctor will place a local anesthetic under the skin in the front of the neck and surrounding the thyroid gland.

Second, using the same entry neck hole, a thin probe will pass into your neck targeting your thyroid nodule. The RFA will start by ablating the deeper and posterior portion of your nodule then proceed to superficial and anterior portions of your nodule.

  • A Popping sound will be heard during RFA as the tissue is sequentially and successfully being ablated.
  • After your ablation, an ice pack will be placed on your neck and you will be monitored for approximately 30 minutes then you will go home.
  • You will be given over-the-counter medications such as acetaminophen  (Tynelol) for inflammation after RFA.

The day after RFA your neck will be mildly sore but you will be able to resume all your normal activity. You will be advised to refrain from extra strenuous activities for 48 hours if possible.

Follow-up after RFA will require periodic ultrasound scans to monitor your nodule size. Also, some thyroid blood work will be repeated.

Why OCC thyroid center for your Graves’ disease treatment?

The OCC thyroid center is accredited by the College of American Pathologists (CAP). Our Center is the first Interventional Cytopathologist In the USA to Perform Thyroid RFA.

  • The Thyroid RFA technique at our center is safe and effective.
  • Our providers are USA-boarded, MD & ECNU certified. Our three doctors have performed more than 50,000 thyroid interventional procedures including  FNA  biopsies, ethanol ablation, and RFA.
  • Our center has been established since 1991 and is considered a national leader in thyroid diagnosis. We have the newest and the highest quality ultrasound and RFA medical equipment.
  • Our center is one of the pioneering thyroid centers in the United States.
  • We offer radiofrequency ablation for benign graves’ nodule treatment that’s performed by our experienced physicians. We only ablate and target your nodule so you can preserve the functions of your gland.
  • Our center has a patient’s centered approach as from our experience we know each patient’s health condition is unique. Additionally, RFA  procedures at our OCC center are more cost-effective than hospital-based procedures as we have no facility fee charge.

Regards to Coronavirus (COVID-19) pandemic and its health implications, we offer an online reservation to help you get the care you need in a safe way