Radiofrequency Ablation for Benign Thyroid Nodules: Updates for Otolaryngologists

Radiofrequency ablation (RFA) has emerged as a well-established minimally invasive alternative to surgery for benign and autonomously functioning thyroid nodules. Over the past two decades, accumulated evidence from systematic reviews, meta-analyses, and long-term cohort studies has demonstrated that RFA achieves substantial and durable volume reduction, with reported volume reduction ratios of approximately 70%–80% at 12 months, 90% at 5 years, and up to 94% beyond 10 years, while maintaining an excellent safety profile with overall complication rates of 2%–3% and permanent major complications below 1%. The procedure preserves thyroid function, eliminates the need for general anesthesia, avoids visible cervical scarring, and enables rapid return to daily activities. Successful outcomes depend on patient selection based on cytologic confirmation of benignity and clinically meaningful symptoms or cosmetic concerns, comprehensive pre-procedural evaluation including ultrasonography and laryngoscopic assessment of vocal cord function, and skilled application of standardized techniques such as the trans-isthmic approach, moving-shot technique, vascular ablation, and hydrodissection. Long-term surveillance is essential, as approximately 12% of nodules demonstrate regrowth and a small proportion of patients ultimately require delayed surgery, often for newly developed lesions rather than treatment failure. Recognized complications including voice change, nodule rupture, and hematoma can be minimized through careful technique and timely management. Otolaryngologists are uniquely positioned to contribute to multidisciplinary RFA practice through their expertise in head and neck anatomy, laryngeal evaluation, and surgical management of complications. This review summarizes current evidence and practical considerations to support safe and effective thyroid RFA in otolaryngologic practice.