Thermal Ablation in Thyroid Cancer Management: A Paradigm Shift in Treatment

Papillary thyroid cancer has experienced increased detection rates due to advanced imaging, creating clinical scenarios where treatment morbidity may exceed the risk posed by the disease. While active surveillance offers passive monitoring for low-risk cases, it lacks objective tumor control methods and imposes a psychological burden on patients living with untreated cancer. In this clinical context, thermal ablation (TA) techniques have gained significant importance as minimally invasive alternatives to traditional surgical approaches in the management of thyroid cancer. TA requires a comprehensive pre-procedural evaluation, including a detailed ultrasonographic assessment of the target lesions and their relationship to critical anatomical structures. Essential laboratory investigations include a complete blood count, coagulation studies, thyroid function tests, and serum thyroglobulin (Tg) levels, along with anti-Tg antibody levels, as well as a mandatory voice assessment. When employing appropriate prevention strategies, including precise electrode positioning, hydrodissection techniques, real-time ultrasound guidance, continuous vocal cord function monitoring, and immediate cessation of energy delivery upon detecting dysfunction, major complication rates remain acceptably low. Current international guidelines have evolved from conservative recommendations to positioning TA as the first-line treatment for T1N0M0 papillary thyroid microcarcinoma. For recurrent thyroid cancer, comparative studies have shown that ablation techniques achieve better recurrence-free survival rates than surgery at multiple time points. The TA represents a paradigm shift in thyroid cancer care, offering effective tumor control while preserving thyroid function, avoiding surgical morbidity, and addressing patient preferences for minimally invasive treatments.

Cite this article as: Öğmen BE, Çakır B. Thermal ablation in thyroid cancer management: A paradigm shift in treatment. Endocrinol Res Pract. Published online August 19, 2025. doi:10.5152/erp.2025.25725.