The clinical utility of thermal ablation procedures in thyroid nodules: Latin American Thyroid Society (LATS) surgical affairs committee expert opinion. Part 2.

Thermal ablation (TA) encompasses various options such as radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA), and high-intensity focused ultrasound (HIFU). The fundamental principle of these techniques involves generating heat to induce coagulative necrosis of the nodules. The rising incidence of thyroid nodules, most of which are benign, has highlighted the importance of minimally invasive methods that effectively control symptoms, address cosmetic concerns, and achieve volume reduction. The potential complications associated with surgical interventions have driven the widespread adoption of TA modalities, now used not only for symptomatic benign thyroid nodules (BTN), including autonomously functioning thyroid nodules (AFTN), but also for low-risk papillary thyroid microcarcinoma (PTMC). The evidence presented in this consensus has demonstrated the comparable effectiveness of TA to surgery for BTN in terms of volume reduction percentage (VRP), resolution of symptoms, and cosmetic concerns. Similarly, TA could be considered a suitable option for treating AFTN when surgery or radioactive iodine (RAI) is contraindicated, or when patients decline either of these options, offering a comparable effectiveness profile to RAI in terms of normalizing thyroid-stimulating hormone levels. For PTMC, TA may serve as an alternative for patients at high surgical risk or those who decline surgery, showing comparable outcomes to surgery in terms of local recurrence and lymph node metastasis. Additionally, TA exhibits a superior safety profile compared to surgery or RAI, characterized by reduced complications, preservation of thyroid function, and shorter hospitalization durations. While evidence on cost-effectiveness in Latin America remains limited, studies conducted in other countries support the implementation of TA as a first-line treatment option for BTN. The lack of economic assessment specific to AFTN complicates its consideration as a primary treatment choice; however, the effectiveness and safety profile suggest that the widespread adoption of TA as a first-line therapy could be considered for carefully selected patients diagnosed with AFTN or PTMC. The Surgical Affairs Committee of the Latin American Thyroid Society conducted a comprehensive review of TA as a primary treatment modality for benign, autonomously functioning, and malignant thyroid nodules to ensure its appropriate utilization in the field.