Thyroid nodules that are benign and are causing local symptoms or are a cosmetic problem can now be treated by a trained endocrinologist with thyroid RFA in their office ultrasound room. Recent FDA approval has allowed US citizens to have this therapy without traveling to Europe or Korea..There is no need for surgery in most cases. Thyroid RF is a first line therapy for these benign nodules.The physicians that will be doing RFA are radiologists, surgeons,and thyroid trained endocrinologists.There are marked differences in the cost depending on the provider and if it is done in a hospital system. Thyroid RFA is an outpatient procedure that can be done in an endocrinologist’s office. It is three to six time less expensive done in the endocrinologists ultrasound room with only a sonologist and a roving nurse.This video will describe how one endocrinologist does Thyroid RFA in his office without general anesthesia or conscience sedation. He uses only local Lidocaine on the thyroid capsule and skin.The patient is awake and can tell if they are having any discomfort or voice changes.The Thyroid RF system used is explained in detail and the tools of ablation including small thin electrode, cooling pump, and grounding pads are explained. RF ablation methods include electrode directed trans-isthmic approach and electrode ablation in various places in the nodule by moving shot technique. Two patients with nodules are seen before during and after the procedure. The prior studies from Europe and Korea has shown low complication rates. 3% for all complications and 1% for more serious complications.The procedure room has an emergency tray with iced saline in case of voice changes. Local pain during the procedure can be treated with decrease in wattage power. Iced saline is available to drink by straw for cooling the esophagus if coughing occurs. 6% elevation of the table to prevent aspiration.Termination of the procedure can rarely occur due to bleeding from neck blood vessels and the patient describing voice changes.The patient may have local neck pain after but this is treated with Tylenol. After observation for one hour the patient may leave and even return to work.