Radiofrequency Ablation for the Treatment of Benign or Low Risk Thyroid Nodule

Inclusion Criteria: * Patient is older than 18 years, is not a surgical candidate or refuses to have surgery * Patient is medically fit to undergo local anesthesia with or without conscious sedation * Patient is able to understand and give consent to participation in the study * Presence of compression symptoms or cosmetic concerns for which patient request treatment of the benign thyroid nodule * Solitary thyroid nodule or dominating nodule that is well-defined in multinodular goiter * Benign nodule is \>= 2 cm in the largest dimension, and has either solid, or predominantly solid composition (\>= 70% volume) without large calcification. Nodule is confirmed as benign (Bethesda II) on at least 2 ultrasound guided fine needle aspirations (FNA) or core needle biopsy (CNB) or a single benign diagnosis of FNA or CNB when the nodule has benign ultrasound features (American College of Radiology \[ACR\] Thyroid Imaging Reporting \& Data System \[TI-RAD\] TR 1-3, American Thyroid Association \[ATA\] very low suspicion) within 6 months of planned RFA * Indeterminate thyroid nodule (atypical cells of undetermined significance \[ACUS\], follicular neoplasm), papillary thyroid carcinoma (PTC) without metastasis or locally recurrent thyroid cancer \< 2 cm in the largest dimension. Nodule cytology is confirmed on a single FNA or CNB when the nodule has concordant ultrasound features (ACR TI-RAD TR 4-5, ATA intermediate-high suspicion) within 6 months of planned RFA * Entirety of the selected nodule is visible on ultrasound without significant extension posterior to trachea or mediastinal component * Selected nodule is amenable to trans-isthmus approach * Normal complete blood count, blood coagulation, serum levels of thyroid hormones, thyrotropin (TSH), calcitonin, and absence of anti-thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) * Patient agrees to participate in the clinical study and to complete all required visits and evaluations * Negative serum or urine pregnancy test for females of childbearing potential at base line pre-procedure evaluation Exclusion Criteria: * Patients with cardiac arrhythmia and/or implanted cardiac device * Hyper-functioning nodules, evaluated by thyroid function test and/or 99mTc-pertechnetate scintigraphic findings * History of neck radiation therapy * Pregnancy * Allergies to medications for anesthesia * Primary thyroid PTC with aggressive histology (tall cell, columnar cell, insular, e.g.) in consultation with cytology, endocrine and surgery team * Extra-thyroidal invasion of PTC OR local nodal/distant systemic metastatic disease * Cystic nodules (\< 70% solid components) * Calcified nodules * Targeted nodule within 0.5 cm from the major vessels, vagus nerve, brachial plexus, and recurrent laryngeal nerve * Patients with contralateral vocal cord paralysis * Uncorrectable coagulopathy with partial thromboplastin time (PTT) \> 1.5 x upper limit of normal (ULN) or international normalized ratio (INR) \> 1.5 or platelet count \<100,000 per mm\^3