Direct Ice Packing for Voice Changes During Thyroid Radiofrequency Ablation: A Retrospective Case Series

Voice change is a recognized complication of radiofrequency ablation (RFA) for thyroid nodules, primarily resulting from thermal injury to the recurrent laryngeal nerve or adjacent structures. Although most cases resolve spontaneously over several weeks to months, timely intervention may help reduce patient discomfort and anxiety. This retrospective case series examined five patients who developed voice changes during or immediately after RFA for benign thyroid nodules and were managed with direct ice packing. Ipsilateral vocal cord (VC) hypomobility was confirmed via real-time laryngeal ultrasound, followed by immediate application of ice to the skin overlying the thyroid. VC movement and skin integrity were assessed every 10 min. All patients achieved complete symptom resolution within 20-50 min (median: 30 min) without complications. No cold-induced skin injury occurred, and no additional treatment was required. While spontaneous recovery cannot be excluded, the relatively rapid improvement observed in this series suggests that direct ice packing may represent a safe, practical, and noninvasive management option for RFA-related voice changes. Further studies are warranted to confirm its efficacy in larger and more diverse populations.