Left thyroid nodule which has enlarged dramatically within the past year. Initially this nodule was 20.3 ml, but later developed a cystic component which increased the size to 27.2 ml. After large volume aspirations of fluid (17 ml), this nodule continued to increase in size, causing symptoms of compression, difficulty with swallowing and anxiety associated with fear of choking . She is avoiding food to avoid choking. The nodule has grown to 40.2 ml and she reports 5/5 symptoms including pain, and has a 4/4 cosmetic score. She has been referred to surgery numerous times but has refused thyroid lobectomy despite progression of symptoms and enlargement of the nodule. All biopsies are benign and TSH is normal at 1.14. She was referred to the Thyroid Nodule Treatment Center for evaluation.