Surgery is the long-established therapeutic option for benign
thyroid nodules, which steadily grow and become symptomatic. The cost of thyroid surgery, the risk of temporary or permanent complications, and the effect on quality of life, however, remain relevant concerns. Therefore, various minimally invasive treatments, directed towards office-based management of symptomatic nodules, without requiring general anaesthesia, and with negligible damage to the skin and cervical tissues, have been proposed during the past two decades. Today, ultrasound-guided percutaneous
ethanol injection and thermal ablation with
laser or radiofrequency have been thoroughly evaluated, and are accessible procedures in specialized centres. In clinical practice, relapsing thyroid
cysts are effectively managed with percutaneous
ethanol injection treatment, which should be considered
therapy of choice. In solid non-functioning
thyroid nodules that grow or become symptomatic, trained operators may safely induce, with a single session of
laser ablation treatment or
radiofrequency ablation, a 50% volume decrease and, in parallel, improve local symptoms. In contrast, hyperfunctioning nodules remain best treated with radioactive
iodine, which results in a better control of
hyperthyroidism, also in the long-term, and fewer side-effects. Currently, minimally invasive treatment is also investigated for achieving local control of small size neck recurrences of
papillary thyroid carcinoma in patients who are poor candidates for repeat cervical
lymph node dissection. This particular use should still be considered experimental.