Thyroid Radiofrequency Ablation: Principles and Practice

Thyroid nodules are commonly encountered in clinical practice, and most are benign and asymptomatic. However, some nodules may cause pressure-related symptoms or cosmetic concerns, requiring therapeutic intervention. Radiofrequency ablation (RFA) has emerged as an ultrasound-guided, minimally invasive treatment option for appropriately selected patients with benign thyroid nodules. By inducing thermal coagulative necrosis within the target lesion, RFA promotes gradual volume reduction through tissue resorption and fibrosis, thereby improving symptoms and cosmetic concerns while preserving normal thyroid tissue. The clinical application of thyroid RFA has expanded beyond benign nonfunctioning nodules to include autonomously functioning thyroid nodules and selected cases of locoregional recurrent thyroid cancer, including cervical lymph node metastases. Nevertheless, thyroid RFA should not be regarded as a simple local ablative procedure. Appropriate patient selection, confirmation of benignity or accurate disease characterization, ultrasound-based assessment of the target lesion and adjacent critical structures, and a clear understanding of treatment goals are essential before the procedure. Safe and effective RFA requires knowledge of the principles of thermal ablation, proper electrode selection, local anesthesia, real-time ultrasound guidance, and standardized techniques such as the trans-isthmic approach, moving-shot technique, and hydrodissection. Post-procedural management is also important for detecting complications, evaluating treatment response, and determining the need for additional treatment. In this review, we summarize the basic principles, indications, pre-procedural evaluation, practical techniques, complications, follow-up strategies, and retreatment considerations of thyroid RFA. Familiarity with these principles and practical considerations may help clinicians apply thyroid RFA safely and effectively in appropriately selected patients.