Voice Outcomes Following Thermal Ablation for Thyroid Nodules: A Systematic Review

To evaluate voice outcomes following thermal ablation techniques for the management of benign and malignant thyroid nodules.

A systematic literature review of PubMed and Embase databases was performed up to March 2025.

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Inclusion criteria were studies with adult patients undergoing thermal ablation for thyroid nodules with reported objective voice outcomes. Data extracted included study characteristics, patient demographics, ablation modality, and objective and subjective voice outcomes.

Eighteen studies comprising 5168 patients were included. Ablation modalities were radiofrequency ablation, microwave ablation, laser ablation, and high-intensity focused ultrasound. Objective pre-procedural assessment of vocal cord function using fibreoptic nasoendoscopy or sonographic evaluation was reported in 2054 patients (39.7%). Post-procedural objective vocal cord assessment was most commonly performed in symptomatic cases, while assessment was routinely performed irrespective of symptoms in 2110 patients (40.8%). The pooled post-procedural vocal cord palsy rate was 1.4%, with most cases being transient. Permanent vocal cord palsy was rare (n = 2, 0.05%). Subjective voice symptoms without objective vocal cord dysfunction were generally mild and self-limiting.

Thermal ablation of thyroid nodules is associated with a low risk of clinically significant voice complications. Most voice changes are transient, although the lack of standardized voice assessment likely underestimates true complication rates. Routine objective laryngeal evaluation and standardized reporting are essential to ensure accurate detection of voice complications, optimize patient counseling, and enhance the safety of thyroid ablation practice.