TL;DR: This blog explains why radiofrequency ablation (RFA) is emerging as a preferred thermal treatment option for select patients with low-risk papillary thyroid microcarcinoma (PTMC), based on recent guideline updates and comparative clinical evidence.
- The American Thyroid Association (ATA) now endorses RFA for intrathyroidal, low-risk PTMC (≤1 cm, cT1aN0M0) in patients who are not ideal surgical candidates or who decline surgery.
- RFA provides effective local tumor control with high rates of complete tumor disappearance, low recurrence, and preservation of thyroid function.
- Compared to microwave ablation (MWA), RFA offers greater procedural control, allowing gradual, targeted thermal diffusion near critical neck structures.
- Clinical data suggest RFA achieves slightly superior volume reduction and long-term lesion resolution, with recurrence rates under 3%.
- RFA is supported by a larger body of long-term evidence, making it a mature, well-validated option within minimally invasive thyroid cancer treatment.
The management of select thyroid cancers continues to evolve as minimally invasive therapies gain more and more clinical validation. While thyroid cancer surgery remains the gold standard for many patients, recent guidelines recognize the role of several thermal ablation modalities in carefully selected cases.
In its August 2025 update, the American Thyroid Association (ATA) endorsed radiofrequency ablation (RFA) for thyroid cancer as an alternative treatment option for low-risk papillary thyroid microcarcinoma (PTMC). This marks an important shift in thyroid cancer treatment paradigms.
In this blog, we’ll compare thyroid cancer radiofrequency ablation to microwave ablation, another thermal modality used in thyroid cancer treatment. Continue reading to learn why RFA may be a non-inferior option for select patients.
RFA’s Role in Low-Risk Thyroid Cancer
The American Thyroid Association supports the use of RFA for patients with intrathyroidal, low-risk papillary thyroid microcarcinoma (≤1 cm, cT1aN0M0) who are not ideal surgical candidates or who decline surgery. In this context, ablation for thyroid cancer offers an active treatment option that avoids thyroid removal while achieving local tumor control.
Clinical studies demonstrate that RFA produces high rates of complete tumor disappearance, low recurrence, and preservation of thyroid function in appropriately selected patients.
RFA vs. Microwave Ablation: Mechanistic Differences
Both RFA and microwave ablation (MWA) are ultrasound-guided, percutaneous treatments that destroy malignant tissue through thermal energy. However, their mechanisms differ.
Radiofrequency ablation generates heat through alternating electrical current, allowing gradual and controlled thermal diffusion. This precision is particularly important in the thyroid, where tumors are often located adjacent to sensitive structures.
In contrast, microwave ablation delivers more rapid, higher-temperature heating that is less affected by local blood flow. While that can increase ablation speed, it can also raise the risk of unintended thermal spread.
Comparative Efficacy and Safety
According to clinical evidence, both modalities are effective, yielding high technical success and low recurrence rates. However, multiple comparative analyses suggest RFA may achieve slightly greater tumor volume reduction and more consistent long-term lesion disappearance. Meta-analyses report near-complete tumor resolution in most RFA-treated lesions, with recurrence rates under 3%.
Importantly, RFA for thyroid cancer has a well-established safety profile when used on well-selected patients, with major complications occurring infrequently. Most adverse effects, should they occur, are transient.
MWA demonstrates similar short-term efficacy. However, this modality has a smaller body of long-term outcome data and fewer years of clinical experience in thyroid applications.
Why Clinicians Should Consider RFA for Thyroid Cancer
When comparing treatment for thyroid cancer using thermal modalities, RFA offers several practical advantages:
- Fine control of the ablation zone
- Uses thinner electrodes
- Is widely supported by international consensus statements
- Avoids the risks of hypothyroidism, scarring, and extended recovery associated with surgery
For clinicians, thyroid cancer radiofrequency ablation represents a mature, evidence-backed option within the expanding spectrum of minimally invasive thyroid care. To learn more about RFA, visit STARmed America’s thyroid RFA resource center.
