Practical Guide for Radiofrequency Ablation (RFA) of Thyroid Nodules

Abstract

Introduction: Radiofrequency ablation (RFA) of thyroid nodules is considered a minimally invasive alternative to conventional surgery in patients with symptomatic benign nodules. Under ultrasound guidance, this technique allows direct visualization of critical structures and significantly reduces soft tissue trauma, offering results comparable to surgery with less morbidity. Technique: RFA is performed with the neck extended, using local anesthesia and high-resolution ultrasound. The transisthmic approach and moving shot technique allow for sequential and precise ablation, minimizing heat dispersion to adjacent structures such as the recurrent laryngeal nerve, trachea, and esophagus. Clinical voice monitoring and the use of hydrodissection in high-risk areas enhance the safety of the procedure. Results: Recent studies show volume reductions of ≥50% in most patients at 6–12 months, with significant improvement in compressive symptoms and cosmetic satisfaction. The incidence of complications is low (<3–4%), most of which are transient and require conservative management, such as temporary dysphonia or minor hematoma. Benefits include reduced postoperative pain and hospital stay, and prompt return to daily life. Conclusions: Thyroid RFA represents a safe, effective, and reproducible procedure for the treatment of selected benign nodules, as well as in specific scenarios of tumor recurrence. Its safety profile and functional outcomes position it as an emerging technique of great value in head and neck surgery. Protocol standardization and appropriate patient selection are key to its success