334 - Outpatient Percutaneous Ablation of Large, Symptomatic Thyroid Nodules: Assessment of Safety and Outcomes

Purpose: While percutaneous ablation has been well studied in benign thyroid nodules, data remains limited regarding the role of ablation in treating very large nodules, which are often more challenging due to longer ablation times and the potential need for multiple ablations. This study aims to assess outcomes within this subgroup, providing insight into whether thyroid ablation can serve as a minimally invasive alternative to surgery.

Materials and Methods: A retrospective analysis was performed of patients who had percutaneous ablation for benign, symptomatic thyroid nodules at a large academic hospital system. Eligible cases included nodules with an initial baseline volume ≥ 20 cc that were treated from 2021-2025. Patients with a post-operative follow-up time of < 12 weeks were excluded. Demographics, symptoms, and pathologic findings based on Bethesda criteria were collected. Pre- and post-operative images were utilized to calculate initial volumes and relative volume reduction (VRR) following ablation. The number of ablation sessions required for each patient was recorded. Clinical outcomes were assessed by evaluating symptom improvement, complication rates, and evidence of recurrence.

Results: Fifty-five thyroid nodules met the above criteria. Five patients had two, separate nodules ablated. The average age was 53.7 years with a majority of the patients identifying as females (84%). The main presenting symptoms included cosmetic concern, dysphagia, and pressure. All nodules were classified as Bethesda II on at least two separate fine needle biopsies (FNB), aside for 5 nodules classified as Bethesda III on at least one FNB, with benign molecular studies. The average initial volume was 57.4 cc with an average VRR of 81.2%. The average number of ablation sessions was 1.5.





Greater than a single ablation was performed in 20 patients. Five of these ablations were performed for recurrence. The remaining ablations were performed as a part of planned, staged ablations.




Minor complications occurred in 3 patients including postprocedural nausea (1) and transient hoarseness (2). Nodule rupture, a known complication of nodule ablation, occurred in 2 patients.

Conclusion: The present findings support percutaneous ablation of large benign thyroid nodules as a potential alternative to surgery, particularly for patients seeking less invasive treatment. Nevertheless, larger prospective studies are needed to further define its role, establish standardized staging protocols, and evaluate long-term outcomes and complication rates.