top of page

Choice in Ablative Therapies for Thyroid Nodules

Choice in Ablative Therapies for Thyroid Nodules

Choice in Ablative Therapies for Thyroid Nodules


Q Lina Hu, Jennifer H Kuo, Choice in Ablative Therapies for Thyroid Nodules, Journal of the Endocrine Society, Volume 7, Issue 7, July 2023, bvad078,



Ultrasound-guided ablation procedures have been growing in popularity and offer many advantages compared with traditional surgery for thyroid nodules. Many technologies are available, with thermal ablative techniques being the most popular currently though other nonthermal techniques, such as cryoablation and electroporation, are gaining interest. The objective of the present review is to provide an overview of each of the currently available ablative therapies and their applications in various clinical indications. RFA is a thermal ablative technique that uses high-frequency alternating electric current to generate heat. As radiofrequency waves agitate tissue ions, their motion under the influence of alternating current produces friction and heat. The temperature can reach up to 100 °C, dehydrating cells and denaturing proteins leading to coagulation necrosis [41]. Heat is generated in the tissue within a few millimeters of the electrode tip and heat conduction from the ablated area leads to additional thermal damage to tissue further from the electrode. As such, RFA efficacy may be limited by tissue carbonization and heat sink effect from adjacent blood flow or cystic components in the target lesion [42]


Many studies have demonstrated the efficacy of RFA for reducing the volume of benign nodules. A meta-analysis by Ha et al showed a pooled volume reduction of 76.1% at 6 months [11]. Long-term studies demonstrated rapid volume reduction at 12 months, a plateau from 12 to 36 months, and further volume reduction after 36 months [12]. A meta-analysis of long-term outcomes reported a pooled volume reduction of 80.3% at 3 years. The overall complication rate was low at 4.6% with 1.3% major complications, including voice change, laryngeal nerve injury, and brachial nerve injury [12]. Generally, RFA is most effective for smaller nodules (volumes less than 10 mL) with larger nodules requiring more than 1 treatment [13]. The most important technical parameter associated with volume reduction is the total energy delivered [14]. Compared with surgery, RFA is associated with fewer complications, better health-related quality of life, and preservation of thyroid function [17, 44, 45]. However, it can take longer to achieve the desired volume reduction. A meta analysis comparing thermal ablation with surgery found no difference in symptom improvement but significantly lower incidence of pain, hoarseness, and hypothyroidism, better cosmetic outcomes, and shorter hospitalization with thermal ablation [46]. In a telephone survey of 126 patients treated with RFA and 84 patient treated with surgery, there was no difference in the overall satisfaction, but more patients were fully satisfied with the resolution of nodule-related symptoms in the surgery group (96% vs 81%) and more patients were fully satisfied with the cosmetic results in the RFA group (92% vs 69%) [15].

Key Words

thyroid nodules, thermal ablation, radiofrequency ablation, microwave ablation, laser ablation, ethanol ablation

Contact Us


2320 N. Third Street
Phoenix, AZ 85004


tel: 602-889-2923
fax: 602-889-2925 / 602-889-2926

Opening Hours

Mon - Thurs

7:30 am – 4:30 pm


7:30 am – 4:00 pm

Closed M-F

12:00 - 1:00 pm Lunch

  • Youtube
  • Facebook
  • Instagram
bottom of page