BACKGROUND
Thyroid nodules are common, found in up to 50% individuals. Nodules that are found to be cancerous (~5% of nodules) are usually treated with surgery. Benign nodules do not have to be removed unless they are large, cause symptoms or are overactive. If the nodule is overactive (toxic nodules), the nodule can be destroyed by radioactive iodine therapy or removed by surgery. If the nodule is not overactive (the majority of benign nodules), surgery was the only option to remove the nodule until recently.

Radiofrequency ablation (RFA) is a non-surgical option to treat benign nodules, including toxic nodules. RFA uses ultrasound to insert a very thin needle into a thyroid nodule then uses heat to destroy the nodule. It is typically recommended for patients who wish to avoid surgery for nodules that are overactive, cause neck symptoms or cosmetic concerns. Often, multiple RFA treatments are needed to shrink and destroy the nodule. There are not many studies that show how well RFA works over a long time for people with toxic nodules and fewer evaluating the effects on a single RFA treatment. This study looks at the short-term and long-term results after one RFA treatment in patients with thyroid nodules.

THE FULL ARTICLE TITLE
Dobnig H, Amrein K. Mid- to long-term outcomes after single radiofrequency ablation of nontoxic and toxic thyroid nodules. J Clin Endocrinol Metab 2026;111(5):1397–1407; doi: 10.1210/clinem/dgaf611. PMID: 41192411.

SUMMARY OF THE STUDY
The researchers studied patients who were treated at a hospital in Austria between 2014 and 2024. All patients had thyroid nodules that were not cancer, confirmed by a biopsy.

There were 896 patients in the study. Of these, 765 had normal-functioning (non-toxic) nodules and 131 had toxic nodules. Each patient had one session of RFA with local anesthesia to numb the skin. The doctors checked on the patients after 3 months, 1 year and then once a year every year. At each visit, they measured the size of the thyroid nodules and checked thyroid hormone levels in the blood. If the nodule grew back to more than half of its previous size it was called a regrowth. If the blood test showed a low TSH level (less than 0.4 mIU/L), it meant that the overactive thyroid nodule had come back.

After 1, 3 and 5 years, the nontoxic nodules became 79%, 82% and 86% smaller. The toxic nodules became 84%, 88% and 89% smaller. After 5 years, the nodules stayed about the same size. About 7% of patients with nontoxic nodules had their nodules grow back. About 11% of patients with toxic nodules had their overactive thyroid problem return. Bigger nodules, especially those larger than 10 ml were more likely to grow back. Older patients were less likely to have their nodule grow back. The treatment was very safe. Only about 4% of patients had complications, and only 0.3% had serious complications

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
RFA worked well for both short- and long-term treatment. It was successful in 83% of patients with nontoxic nodules and 78% of patients with toxic nodules. The treatment was also safe. People who had smaller thyroid nodules and were older had a better chance of getting good results. These findings can help doctors explain the treatment to patients and choose the people who are most likely to benefit from RFA.

—Susana Ebner MD

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