US-Guided Thermal Ablation Safe and Effective for Thyroid Nodules
Patients experience volume reduction and stable thyroid function after treatment
US-guided thermal ablation may expand treatment options for patients with benign thyroid nodules. In a new study from China, researchers evaluated the technique as both an initial treatment and for nodules recurring after prior thyroid surgery.
“Regardless of a prior history of thyroid surgery, there was no significant difference in the incidence of complications between the two groups of patients with benign thyroid nodules who underwent thermal ablation, demonstrating favorable safety profile and tolerability,” said study senior author Li-Ping Sun, MD, PhD, from Shanghai Tenth People’s Hospital and the School of Medicine at Tongji University in Shanghai. “These findings provide valuable references for clinicians to select thermal ablation as a first-line alternative for patients with recurrent nodules after thyroid surgery.”
Exploring Safer Nodule Treatments
Thyroid nodules are common, mostly benign growths in the thyroid gland at the front of the neck, affecting up to 60% of adults, according to the National Institutes of Health. Clinical guidelines recommend surgery for thyroid cancer and benign nodules that cause compression symptoms or cosmetic problems. However, many patients go on to develop additional nodules that require repeat surgeries which carry an increased risk of complications.
Minimally invasive image-guided techniques, such as radiofrequency ablation, have emerged as alternatives to surgery, though limited research exists on the efficacy and complication rates for their use in patients with recurrent benign thyroid nodules who have undergone prior lobectomy.
To address this gap, Dr. Sun and colleagues conducted a study to learn more about US-guided thermal ablation as a first-line treatment for initial nodules and as a second-line treatment for recurrent nodules after previous thyroid surgery. The study group consisted of 222 patients, including 148 in the initial nodule group and 74 in the recurrent nodule group.
US images in a 47-year-old woman with a benign thyroid nodule in the right lobe of the thyroid gland who underwent microwave ablation. (A) Contrast-enhanced image of the nodule (arrows) before ablation. (B) Image after injection of a mixture of 0.9% saline and lidocaine to isolate the thyroid gland from surrounding critical structures (the outline of the white curve shows the resulting water-isolated area). (C) Image shows the hypoechoic zone produced by the ablation needle within the nodule during ablation (arrows). (D) Postablation contrast-enhanced image shows no contrast agent perfusion within the nodule (arrows).
https://doi.org/10.1148/rycan.240431 ©RSNA 2026
“Our analysis showed no difference between the two groups regarding incidence of major complications, minor complications or adverse effects,” Dr. Sun said. “The difference in volume reduction rate between the two groups at each follow-up point was not statistically significant.”
“At the last follow-up visit, both groups in the study achieved a significant volume reduction, with substantial improvements observed in patient-reported symptoms and cosmetic scores,” he added. “In addition, the thyroid function of patients in both groups remained stable after thermal ablation.”
Key Factors Guide Safe, Effective Care
Thermal ablation has important benefits over surgery. The procedure is performed under local anesthesia as either a day surgery or an outpatient procedure. It does not leave a scar, and its minimal invasiveness allows for rapid postoperative recovery.
Dr. Sun recommended that optimal treatment strategies be determined on a case-by-case basis by integrating the pathological results of fine-needle aspiration biopsy, nodular imaging features and patient preferences.
“For benign nodules or low-risk papillary thyroid carcinoma, thermal ablation can serve as a first-line treatment modality when patients decline surgical intervention or are not eligible for surgery,” Dr Sun said. “In contrast, surgery should be the preferred option for patients with nodules complicated by lymph node metastasis or extrathyroidal extension.”
Accurate preoperative assessment of the nodule and its relationship with surrounding anatomical structures is a crucial factor for a successful thermal ablation procedure, he noted. Other key factors include:
- Experienced operators trained in ablation techniques.
- Real-time US monitoring throughout the entire ablation procedure.
- Standardized operational protocols.
- The application of auxiliary techniques, such as fluid isolation solutions.
- Intraoperative vital signs monitoring
- Standardized postoperative management and long-term follow-up.
Dr. Sun and colleagues plan to initiate a multicenter long-term follow-up study to enhance the generalizability of the research conclusions. As part of the study, they will analyze differences in ablation efficacy and safety among distinct subgroups of patients stratified by different previous thyroid surgical approaches.
“In addition, we are conducting a specialized study focusing on treatment modality selection for patients with newly developed thyroid nodules with a history of prior thyroid surgery,” he said. “This study aims to investigate and compare the safety and effectiveness, changes in thyroid function, and patient-reported quality-of-life scores between repeat thyroidectomy and thermal ablation for the management of such recurrent nodules.”
For More Information
Access the Radiology: Imaging Cancer study, “Safety and Efficacy of Thermal Ablation for Benign Thyroid Nodules in Patients with or without Previous Thyroid Surgery.”
Read previous RSNA News stories on interventional radiology:
- Minimally Invasive Procedure May Spare Patients from Thyroid Surgery
- Interventional Oncology: On the Forefront of Cancer Care and Innovation
- Minimally Invasive Procedure Effectively Treats Small Kidney Cancers