Update on Interventional Techniques for Thyroid and Parathyroid Pathologies

Over the past two decades, interventional techniques in cervical endocrine pathology have evolved significantly, offering less invasive alternatives to conventional surgery. This update reviews the latest advances in non-surgical approaches, including percutaneous ethanol injection (PEI) and thermal ablation (TA), with a focus on their indications, efficacy, and safety profiles. PEI remains the treatment of choice for cystic thyroid nodules. The technique involves ethanol-induced tissue necrosis, leading to significant nodule shrinkage. PEI is simple to perform, with a low risk of major complications, though transient local pain is a common minor side effect. Thermal-ablation, encompassing radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA), utilizes thermal energy to induce controlled tissue necrosis. It has become a well-established option for benign solid and mixed thyroid nodules, and in selected cases, for autonomously functioning thyroid nodules. Increasing evidence also supports its role in the management of low-risk papillary thyroid carcinoma, demonstrating favorable oncologic outcomes. TA is now recognized as a viable alternative for locoregional recurrent thyroid cancer, particularly in patients at high surgical risk or those who refuse surgery. Its use ranges from curative to palliative intent, depending on disease extent and patient factors. For parathyroid adenomas, TA may be considered a first-line treatment for intrathyroidal adenomas, avoiding unnecessary thyroid lobectomy. In exceptional cases, it may serve as a second-line therapy for patients who are either ineligible for surgery or opt against it. These minimally invasive techniques continue to gain prominence, broadening their indications and refining procedural protocols. This update underscores their role in modern endocrine practice, aiming to optimize patient outcomes while preserving thyroid and parathyroid function.