Non-surgical, Image-guided Management of Benign Thyroid Nodules

Most thyroid nodules are cytologically benign and can be managed nonsurgically. Asymptomatic benign nodules require follow-up without treatment. Cosmetic problems and/or compression-related symptoms may be indications for treatment. Until now in clinical practices, nonsurgical image-guided therapy includes percutaneous ethanol injection, radiofrequency ablation, laser ablation, and high intensity focused ultrasound. Percutaneous ethanol injection should be used as the first-line therapy for recurrent symptomatic cystic nodules. Radiofrequency ablation is an effective procedure for obtaining shrinkage and improving symptoms of solid thyroid nodules. Better understanding of image-guided therapy makes physicians personalize the management of benign thyroid nodules according to a cost-benefit analysis.