Thyroid nodules are a prevalent condition in India, with a prevalence rate of 12.2%. In 19-35% of cases, benign tumors are detected incidentally and typically referred to as Incidentalomas. In the clinical context, the mandatory evaluation of thyroid nodules is not required, but it becomes necessary if the nodule size exceeds 1 cm. 

The evaluation process involves Serum TSH testing to differentiate between hypo and hyperfunctioning organs, ultrasound to distinguish between benign and malignant tumors, and FNAC (Fine Needle Aspiration Cytology)/Core biopsy. Ultrasound assessments utilize TI-RADS (Thyroid Imaging Reporting and Data System) categories to standardize reporting and manage thyroid nodules. TI-RADS categorizes nodules into six risk levels, providing a structured way to communicate malignancy risk to clinicians.

Benign thyroid nodules can be categorized into various types, including colloid/hyperplastic nodules, toxic/non-toxic multinodular goiter, cysts, and nodules related to thyroiditis. Not all nodules require treatment; only symptomatic ones necessitate surgical intervention. Asymptomatic benign tumors only require periodic follow-ups.

Traditionally, surgical procedures like thyroidectomy or hemithyroidectomy were used to treat benign thyroid tumors. However, they were associated with complications, including hypoparathyroidism and the requirement of thyroid hormone supplementation. 

To counteract these issues related to surgery, minimally invasive therapy has been approved by the guidelines for benign symptomatic tumors only. The benefits of these procedures are no need for general anesthesia, no surgical incision, no removal of thyroid tissue, and a daycare procedure performed with ultrasound guidance. 

Currently, two minimally invasive options are available, including chemical ablation (Ethanol ablation for cystic nodules) and thermal ablation (Radiofrequency ablation and microwave ablation). In 2020, the European Thyroid Association developed guidelines for image-guided ablation in benign thyroid nodules. 

The treatment algorithm involves initially confirming the benign nature through two FNACs at different times or a biopsy using a 20-gauge needle. Further testing is conducted to eliminate suspicion of malignancy, particularly in patients with calcified tumors. Serum tests are performed to determine TSH and calcitonin levels.

For lesions categorized as purely cystic or predominantly cystic, ethanol ablation is the preferred first-line treatment. In cases of purely solid lesions, microwave/radiofrequency ablation is favored. A combination of chemical and thermal ablation is employed for combined solid and cystic lesions. These ablations are carried out under local anesthesia, with lidocaine infiltrated up to the capsule. 

Challenges associated with the procedure include the risk of damage to carotid arteries, the danger triangle, etc. Patients receive a local glucose infusion to mitigate these risks and separate these structures from the gland. The procedure typically takes around 45 minutes, and patients are advised to use ice packs and local compression to reduce inflammation and pain. Follow-up appointments are scheduled at 48 hours, two weeks, three months, and six months. Overall, a reduction in tumor size is typically observed within three months.