Nerve Injury During Thyroid Radiofrequency Ablation: Mechanisms, Prevention, and Practical Management

Voice change is an uncommon but clinically important complication of thyroid radiofrequency ablation (RFA), because it may indicate injury to the recurrent laryngeal nerve or, less commonly, the vagus nerve. Early recognition and appropriate intervention are important, because neural dysfunction may remain reversible before the occurrence of irreversible structural nerve injury. Thermal nerve injury during thyroid RFA is not always a single instantaneous event. Rather, it may involve direct thermal exposure of the nerves, leading to acute endoneurial or perineural edema, microvascular compromise, and delayed inflammation or fibrosis. Therefore, a practical approach to the management of voice changes during thyroid RFA should emphasize prevention, frequent intraprocedural voice assessment, immediate cessation of ablation, and prompt bolus injection of cold 5% dextrose in water. After adequate cooling, local dexamethasone injections and a short course of oral corticosteroid therapy may be considered. In conclusion, a mechanism-based framework may improve operator preparedness and reduce the risk of persistent nerve dysfunction.