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HOME > Endocrinol Metab > Volume 40(3); 2025 > Article
Editorial
Thyroid Long-Term Outcomes of Radiofrequency Ablation in Patients with Low-Risk Papillary Thyroid Microcarcinoma
Hunjong Lim1orcid, Min Joo Kim2,3orcid
Endocrinology and Metabolism 2025;40(3):385-387.
DOI: https://doi.org/10.3803/EnM.2025.2432
Published online: June 11, 2025

1Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea

2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Min Joo Kim. Department of Internal Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea Tel: +82-31-787-7855, Fax: +82-31-787-4052, E-mail: chorong24@gmail.com
• Received: May 5, 2025   • Accepted: May 19, 2025

Copyright © 2025 Korean Endocrine Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Active surveillance (AS) is increasingly recognized as a feasible management strategy for patients with low-risk papillary thyroid microcarcinoma (PTMC), offering the benefit of avoiding immediate surgery. However, despite its demonstrated effectiveness and safety, many patients remain hesitant to choose AS due to anxiety and fear regarding potential disease progression, along with the psychological burden associated with living with untreated cancer [1,2]. In this context, radiofrequency ablation (RFA) has emerged as a potentially effective and safe therapeutic alternative capable of addressing these concerns [3]. According to a recent international multidisciplinary consensus statement, ultrasound-guided ablation procedures, including RFA, can be considered in selected patients with PTMC who are unsuitable for surgery or who decline both surgery and AS [4].
There have been concerns regarding the effectiveness of RFA because the procedure does not always definitively confirm complete tumor eradication. Even if a nodule appears to have disappeared on follow-up ultrasound, concerns may persist about residual cancer [5]. Moreover, post-ablation changes in sonographic appearance require careful interpretation, emphasizing the need for an evaluation by experienced operators. Nevertheless, when an adequate ablation zone—encompassing surrounding normal thyroid tissue—is achieved, the risk of marginal recurrence can be minimized. With meticulous follow-up, early detection of recurrence remains feasible and manageable. Numerous short-term studies with relatively small sample sizes have reported the efficacy and safety of RFA in low-risk PTMC. A meta-analysis of 15 such studies demonstrated an overall tumor progression rate of 1.5% with a mean follow-up of 33 months, and lymph node metastasis occurred in only 0.2% of cases [6].
More recently, Li et al. [7] published the largest long-term study to date evaluating RFA for low-risk papillary thyroid carcinoma (PTC). This retrospective cohort study, conducted at the Chinese People’s Liberation Army General Hospital, included 1,613 patients with solitary PTC ≤2.0 cm (88% ≤1.0 cm), treated between 2014 and 2020. The median follow-up duration was 58.5 months (range, 27 to 111). Disease progression occurred in 4.3% of patients, including recurrence in 2.6% and persistent disease in 1.7%. The disease progression rate was 3.7% among patients with tumors ≤1.0 cm (T1a) and 8.8% in those with T1b disease. Notably, complete tumor disappearance was observed in 85.3% of cases.
The outcomes of RFA reported by Li et al. [7] were compared with those from AS and surgery [8-10] and are presented in Fig. 1. Compared with outcomes from meta-analyses of AS studies—where 5-year tumor growth and lymph node metastasis rates were 5.3% and 1.6%, respectively [8]— RFA appears to offer lower progression rates. Because RFA may provide definitive treatment in some cases, the long-term benefits of RFA could become increasingly evident over time. Supporting this view, a recent study with over 10 years of follow-up involving 65 patients reported a complete disappearance rate of 100% at 24 months after an average of 1.2 RFA sessions [11]. However, 7.7% of patients developed new thyroid cancers in the remaining thyroid tissue during follow-up.
Several caveats must be considered when interpreting RFA outcomes. These outcomes can vary significantly depending on appropriate patient selection and the expertise of the operators performing both the ablation procedure and post-treatment imaging interpretation (e.g., ultrasound and computed tomography). Follow-up adherence is another critical factor. In the study by Li et al. [7], 438 (21.4%) out of 2,051 patients initially treated with RFA were lost to follow-up. Unlike surgical patients, those treated with RFA rarely develop hypothyroidism, potentially reducing their motivation for continued follow-up. Furthermore, unlike patients undergoing AS, those receiving RFA might perceive their cancer as cured, potentially diminishing their adherence to regular follow-up.
Although RFA is generally considered safe, complications such as pain, hematoma, and voice changes can occur. In the study by Li et al. [7], complications occurred in 2.0% of patients, with 0.4% experiencing voice changes lasting longer than one month. Voice change represents the most significant longterm adverse event associated with RFA. Consequently, current guidelines recommend subjective voice assessments prior to RFA [4]. Previous studies on RFA for benign thyroid nodules and recurrent thyroid cancers reported a rate of permanent voice change of approximately 1.4% [12]. However, in RFA for low-risk PTMC, the reported rate of voice change persisting beyond 1 month is less than 0.1% [6]. In cases of nerve injury, the use of cold 5% dextrose injection can effectively mitigate damage. Most RFA-related complications are transient and self-limiting. To date, no life-threatening complications have been reported [13], supporting the overall favorable safety profile of RFA in low-risk PTMC.
In conclusion, RFA is a promising treatment option for selected patients with low-risk PTMC who prefer an alternative to surgery or AS. To clearly define its role in standard clinical practice, further long-term, prospective, multicenter studies are required. Additionally, the development of standardized indications and procedural guidelines for RFA in PTMC will be essential to ensure consistent and safe application. With accumulating evidence, RFA is poised to become an important component of personalized care for patients with low-risk PTMC.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

Fig. 1.
Comparison of clinical outcomes among active surveillance (AS), radiofrequency ablation (RFA), and surgery for low-risk papillary thyroid microcarcinoma. LN, lymph node; FU, follow-up.
enm-2025-2432f1.jpg
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  • 2. Hwangbo Y, Choi JY, Lee EK, Ryu CH, Cho SW, Chung EJ, et al. A cross-sectional survey of patient treatment choice in a multicenter prospective cohort study on active surveillance of papillary thyroid microcarcinoma (MAeSTro). Thyroid 2022;32:772–80.ArticlePubMed
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  • 4. Orloff LA, Noel JE, Stack BC Jr, Russell MD, Angelos P, Baek JH, et al. Radiofrequency ablation and related ultrasound-guided ablation technologies for treatment of benign and malignant thyroid disease: an international multidisciplinary consensus statement of the American Head and Neck Society Endocrine Surgery Section with the Asia Pacific Society of Thyroid Surgery, Associazione Medici Endocrinologi, British Association of Endocrine and Thyroid Surgeons, European Thyroid Association, Italian Society of Endocrine Surgery Units, Korean Society of Thyroid Radiology, Latin American Thyroid Society, and Thyroid Nodules Therapies Association. Head Neck 2022;44:633–60.PubMed
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  • 11. Jeong SY, Baek SM, Shin S, Son JM, Kim H, Baek JH. Radiofrequency ablation of low-risk papillary thyroid microcarcinoma: a retrospective cohort study including patients with more than 10 years of follow-up. Thyroid 2025;35:143–52.ArticlePubMed
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  • 13. Lee MK, Baek JH, Chung SR, Choi YJ, Lee YM, Kim TY, et al. Effectiveness of injecting cold 5% dextrose into patients with nerve damage symptoms during thyroid radiofrequency ablation. Endocrinol Metab (Seoul) 2020;35:407–15.ArticlePubMedPMCPDF

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        Long-Term Outcomes of Radiofrequency Ablation in Patients with Low-Risk Papillary Thyroid Microcarcinoma
        Endocrinol Metab. 2025;40(3):385-387.   Published online June 11, 2025
        DOI: https://doi.org/10.3803/EnM.2025.2432
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      Fig. 1. Comparison of clinical outcomes among active surveillance (AS), radiofrequency ablation (RFA), and surgery for low-risk papillary thyroid microcarcinoma. LN, lymph node; FU, follow-up.

      Fig. 1.

      Long-Term Outcomes of Radiofrequency Ablation in Patients with Low-Risk Papillary Thyroid Microcarcinoma
      Endocrinol Metab : Endocrinology and Metabolism
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