Radiofrequency and Microwave Ablation as Minimally Invasive Approaches for Managing Benign Thyroid Nodule

The management of benign thyroid nodules has evolved significantly with the advent of minimally invasive techniques, offering patients effective alternatives to traditional surgery. Among these, radiofrequency ablation (RFA) and microwave ablation (MWA) have emerged as the leading modalities. RFA, the most widely adopted method, uses high frequency alternating current to induce thermal coagulation. MWA, though less established in thyroid applications, employs electromagnetic waves to generate rapid and intense heat, making it particularly effective for larger or hypervascular nodules. These approaches are particularly advantageous for patients with symptomatic nodules or cosmetic concerns, as they preserve thyroid function while minimizing complications and recovery time. This protocol establishes a standardized approach for RFA and MWA of benign thyroid nodules. The procedure begins with cytological confirmation (Bethesda II) and ultrasound evaluation, followed by local anesthesia and protective hydrodissection with 40-80 mL of 5% dextrose or distilled water to safeguard critical structures. Under real-time ultrasound guidance, the trans-isthmic approach is employed for needle placement. Ablation is performed at 30-40 W (RFA) or 35-50 W (MWA) using the moving-shot technique. Complete nodule devascularization is confirmed by contrast-enhanced ultrasound (CEUS) during post-ablation assessment, with immediate supplementary ablation being performed if residual enhancement is identified. Clinical and sonographic follow-up is conducted at 1, 3, 6, and 12 months to assess volume reduction ratio, symptom relief, and cosmetic outcomes. The protocol also details the patient selection criteria, technical nuances for cystic/solid nodules, and management of intraoperative complications. This comprehensive guide aims to optimize the reproducibility, safety, and efficacy of thermal ablation for benign thyroid nodules, serving as a practical reference for clinicians adopting these minimally invasive techniques.