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

Year: 2026

Type: review

Abstract: 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.

Source: Korean Journal of Radiology

DOI: 10.3348/kjr.2026.0878

Authors: Hunjong Lim, Jung Hwan Baek

Institutions: Seoul National University, Seoul National University Bundang Hospital, Asan Medical Center, University of Ulsan

Language: English

Topic: Thyroid and Parathyroid Surgery

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Funder: Seoul National University Bundang Hospital