Ultra-minimally invasive thermal ablation treatment of thyroid nodules using microwave, radiofrequency, laser and other high-tech physical therapy under ultrasound guidance has become increasingly popular with both patients and physicians because this treatment technology not only has a very high cost-benefit ratio, such as less time consuming, quicker recovery, shorter hospitalization time and less financial cost, but also has a very high recovery index, such as the ability to completely inactivate the lesion, protect the patient’s normal thyroid function from the inconvenience and trouble caused by long-term use of Eugenol, and protect the immune function of the patient’s cervical lymph nodes without skin scars to fully meet the patient’s cosmetic needs. Since 2005, we have successfully completed more than 10,000 cases of thermal ablation of thyroid nodules, and patients have benefited from this minimally invasive treatment technology. After the ablation of thyroid nodules, the follow-up and evaluation of the efficacy of the treatment has now become a common concern for both patients and doctors. Usually, before the ablation treatment, ultrasound examinations of the thyroid gland and cervical lymph nodes are performed, blood is drawn to check thyroid function indicators, patients are asked to score their clinical performance according to the clinical symptom scale, and of course, there is an essential pathological diagnosis by puncture biopsy. This basic preoperative information is an important comparison for later evaluation of efficacy and side effects. It goes without saying that these tests must be revisited after ablative treatment and repeated at 1, 3, 6 and 12 months after the procedure according to the time points. The major difference between ablation therapy and surgical excision (open surgery) is that the lesion is not taken out of the body, but is allowed to undergo necrosis in its original location and gradually shrink until it disappears. Therefore, patients should be prepared that the nodule will still exist for some time after treatment, but they should understand that the nodule after treatment is no longer a lesion, but an ablation zone that will be coagulated and necrosis will occur. Before the ablation, the nodule cells are supplied with blood and have vitality, but immediately after the ablation, the blood vessels are occluded and the blood flow is stopped, so that the nodule cells are deprived of food supply. The first stage is the thermal coagulation treatment process, the result of which is to turn the originally living focal nodules into dead tissue with loss of vitality, the main task of the doctor has been completed at this stage; the second stage is the immunophagocytosis of the ablation area, the result of which is the gradual atrophy of the ablation area. Both microwave and radiofrequency have a strong dehydrating effect, with microwave being stronger. Most thyroid nodules are rich in water, and after ablation there is water loss, the nodules harden, and the nodules become more compact, so they are instead harder to touch than before treatment. After ablation, the blood supply in the ablation zone has been lost, indicating that the lesion tissue has been completely inactivated, but there can be blood flow signal in the normal tissue around the ablation zone, and the presence of this blood flow signal indicates that the ablation treatment has not injured the innocent and will also help the absorption of the necrotic area. The ultrasound image performance of the ablation zone will become somewhat messy, which can be easily misjudged as malignant tumor by ultrasonographers who are not experienced in this kind of treatment and make patients panic. Therefore, please ask your friends to firstly, try to go back to the doctor who did the ablation for you to review, and secondly, find out whether the local ultrasonographer who did the examination for you has experience in ablation treatment to know whether his conclusion is biased or not. Anyway, there is one thing that we firmly believe: the necrotic tissue after ablation can never evolve into cancer. During the follow-up ultrasound examination, patients may find that the ablation area is larger than the previous lesion in the first month, and they may wonder if the nodule has increased rapidly after stimulation. In fact, it is too much to worry. The thyroid tissue removed during open surgery must be larger than the lesion, otherwise the lesion is not completely removed. By the same token, the ablation area must be larger than the size of the nodule lesion, or else there will be incomplete ablation. As mentioned above, the ablation zone will gradually become smaller as the immunophagocytic clearance process extends, so the ultrasound measurement will tend to decrease at the 3rd, 6th and 12th month. After the ablation, the 7 indicators of thyroid function are checked by blood sampling. Some patients may find a slight increase or decrease in T3 and T4, and they are worried if they have hyperthyroidism or hypothyroidism. During the ablation process, hormones from the thyroid tissue enter the bloodstream along the puncture needle tract, leading to an increase in T4 and T3, or because the patient has too many thyroid nodules, the normal tissues are squeezed and suppressed, and it is too late to release the hormones in time after the ablation, leading to a transient decrease in T3 and T4. Most of these changes are self-correcting and return to normal after about 1~3 months, which is not hyperthyroidism or hypothyroidism at all and no treatment is needed. In addition to slight fluctuations in T3 and T4, the antibodies TPO-Ab and Tg-Ab can also fluctuate, and sometimes even increase to a frightening degree, because the antigens that cause these two antibodies to rise are abundant in the thyroid tissue. Some people have a higher sensitivity to immune response and produce higher antibodies. The key is to see whether these elevated antibodies will have adverse effects on the body. So far, there has not been any case where these two types of elevated antibodies have brought adverse effects to patients after ablation, so we usually do not pay excessive attention or correct them. The last point is that people are concerned about the effectiveness and safety of thyroid cancer ablation treatment. We can tell you with certainty that thermal ablation therapy can completely cure thyroid cancer (excluding medullary carcinoma and undifferentiated carcinoma, mainly papillary carcinoma and follicular carcinoma, especially microscopic carcinoma), and we will closely follow every thyroid cancer patient and evaluate them by puncture.