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Objective  Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team.    Methods  A retrospective cohort study of the first 103 patients receiving RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the percentage of patients with a 6-month nodal volume reduction ratio (VRR) &gt;50% after single-session RFA. Optimal treatment efficacy was defined as a 6-month VRR &gt;50% achieved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions.    Results  Median nodal volume at baseline was 12.0 mL (range 2.0–58.0 mL). A 6-month VRR &gt;50% was achieved in 45% of the first 20 patients, 75% of the next 20, and 79% of the following 63 patients. Complications included minor bleeding ( N  = 4), transient hyperthyroidism ( N  = 4), and transient loss of voice ( N  = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patients. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma.    Conclusion  About 40 procedures are required to achieve a 6-month VRR &gt;50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR &lt;50% and in those with regrowth to exclude underlying malignancy.

Radiofrequency ablation for symptomatic, non-functioning, thyroid nodules: a single-center learning curve