What factors do you consider when deciding between RFA and surgery for a patient with a benign thyroid nodule causing dysphagia?

I primarily examine the risk of anesthesia/surgery and size of the biopsy-proven benign nodule when using ablation (thermal: RFA or microwave). We are still in a period where insurance companies just got a ICD9 for the procedure (RFA only) and it is not clear whether all insurance company will pay. It also depends on the size of the nodule. Generally, RFA is not recommended for > 40 cc (3-4 cm) nodule BUT dysphagia is usually improved with partially reduction in size. RFA usually does not result in total ablation of the nodule. Expect 50-80% reduction in size and even less for larger nodules. So if the patient has medical problems such as CAD, recent CV event, and modest size nodule, AND the insurance will pay for the procedure consider an ...