Table 2.

An overview of the non-surgical, Image-Guided, Minimally Invasive Therapy for thyroid nodules or recurrent thyroid cancer.

Clinical Indication		Treatment
		First line	Second Line
Cysts or predominantly cystic benign thyroid nodules	Cystic nodules (>90% of fluid composition) Predominantly cystic nodules (51–90% of fluid component)	Us-guided percutaneous ethanol ablation (PEI)	Us-guided thermal ablation RFA can be recommended as the next step in cases with incomplete resolved symptoms due to the residual solid component or recurrence following PEI
Solid non-functioning (cold) benign thyroid nodules	Benign, non-functioning solid nodules with symptoms or cosmetic problems Benign, non-functioning solid nodules that progressively enlarge Benign multinodular goiter in patient who refuse or cannot undergo surgery	Thermal ablation (Radiofrequency ablation, laser ablation) Surgery
Autonomously functioning thyroid nodules (AFTN)		Radioactive iodine (RAI) Surgery	Thermal ablation (Radiofrequency ablation, laser ablation)
Primary Thyroid Cancer Follicular neoplasm		Surgery	Thermal ablation Who refuse surgery or who cannot undergo an operation, thermal ablations can be considered as an alternative. Radiofrequency ablation, laser ablation, and microwave ablation have been attempted for patients with papillary thyroid microcarcinoma (PTMC).
DTC patients with metastatic disease		Surgery TSH-suppressive thyroid hormone therapy for patients with stable or slowly progressive asymptomatic disease 131-I therapy for RAI-responsive disease	External beam radiation therapy Thermal ablation Systemic therapy with kinase inhibitors