Don’t do the harmful thyroid nodule ablation? The more you debate the truth, the clearer it becomes! As the doctor with the most number of cases and the most experience in doing radiofrequency/microwave thyroid nodule ablation in Xi’an, Shaanxi Province, I have two profound experiences: firstly, it is difficult to carry out this technology widely, and secondly, I have heard two opposite voices that are strongly in favor and strongly against it. Many professors in large hospitals disagree with it and think that the effect of thyroid nodule ablation is incomplete, residual, easy to recur, and easy to damage the laryngeal nerve, which is a harmful technology. 2. The voice of strong support comes from the majority of patients, especially my own patients. The effect is good, nail function is not affected without the need to take eugenol, no incision without incision, small trauma and fast recovery. According to the Expert Consensus on Thermal Ablation Treatment of Benign Thyroid Nodules, Microscopic Cancer and Metastatic Lymph Nodes in the Neck, the indications for ablation of various thyroid nodules are clearly defined. Why do experts in various specialties not agree with the ablation technique of thyroid nodules even though they are familiar with this expert consensus? The main reason is that experts have seen too many patients with complications after ablation and patients with very unsatisfactory results. The requirements for a good thyroid nodule ablation are very, very high: 1. superb ultrasound technology. The ablation of thyroid nodules must be performed with the help of color ultrasound equipment, which requires a solid ultrasound theoretical foundation, skilled ultrasound operation techniques, and keen eyes to recognize and identify pictures. 2.Precise needle puncture skills under ultrasound. This is the most important and the most difficult skill to master. The general ultrasonographer can only read the chart, but not puncture. Some doctors rely on a “needle guide” to do this, with a fixed angle and rigid movements. It is like a toddler’s walker, you have to give it up to learn to walk. To perform a good thyroid nodule puncture, you must work with both your right and left hands, holding the ultrasound probe in one hand and the needle in the other. The thyroid gland is on the left and right, so you have to be able to exchange your hands at any time, to do your heart, hand, eye and needle at any time. To do this with both hands as you wish is not something that can be practiced in a day or two, but must be practiced repeatedly over a long period of time (I personally used to take pork and beef and pork and liver every day and insisted on practicing for six months) to form a muscle memory of both hands. Thyroid nodules are three-dimensional, while ultrasound images are two-dimensional. If you rely on the “needle guide frame” to do ablation, you can only complete the treatment of a few points and lines, but not to meet a three-dimensional spherical treatment. If you don’t have the skill of “pointing and hitting”, you can finish the ablation on the two-dimensional plane at most, and the ablation will definitely be incomplete, residual and unsatisfactory. 3. Knowledge of anatomy. At present, there are two kinds of doctors who do ablation of thyroid nodules in China: ultrasound doctors, who account for the majority, and surgeons, who account for a small percentage. The anatomy of the thyroid gland is not difficult, but the surrounding organs include the trachea and esophagus, and the vascular nerves. The difference is that the ultrasonographer’s understanding of anatomy is only in the image performance and book memory; while the surgeon’s familiarity with anatomy comes from the usual open thyroid surgery table real knife cut, see and feel. Therefore, ultrasonographers are most worried about damaging the “recurrent laryngeal nerve” when doing thyroid ablation, as they only know the approximate location of the recurrent laryngeal nerve, and will be timid if the nodule is close. Therefore, when surgeons do thyroid nodule ablation, they use the flesh and blood anatomy in their mind to guide the image anatomy, but surgeons, especially those in large hospitals, have difficulty in learning the theory and practice of ultrasound, and sometimes they are not able to do so because hospitals do not provide ultrasound equipment for surgery. Therefore, it is very, very difficult to do a good ablation of thyroid nodules with good results, which must meet the above three requirements; it is very, very difficult to train a good thyroid ablation surgeon. Many doctors in many hospitals have tried to carry out the procedure, but they have always given up because of the difficulties, or they have experienced complications because they were not proficient in the first stage and did not meet the above three requirements, and they were severely stopped by their colleagues and leaders. This is why “it is difficult to carry out widely” and “strong opposition”. Many famous professors, who have seen and heard patients with poor results, residuals, recurrence and complications after thyroid ablation, in addition to some physicians who ignore the indications, some Hashimoto’s thyroiditis, goiter or nodules do not need to be done also to do, etc., it is considered that this method is too undesirable and considered to be a technique that fools people under the guise of minimally invasive. This makes it difficult for doctors, and also for patients. Doctors want to carry out, but there are many difficulties and resistance; patients want to do, but some say it is good and some say it is not reliable. This article hopes to solve the mystery in your mind and find the truth of “don’t do harmful thyroid nodule ablation”. A recommendation for patients: choose a regular hospital and a doctor who has done a lot of cases. A piece of advice for doctors: If you think hard, think hard, ask for advice, practice hard and summarize hard, the opportunity is always reserved for those who are prepared.