Informed by case reports and systematic analysis of the literature, this study aims to offer diagnostic and treatment insights for the early identification of nodule rupture.

This study reports on three cases of nodule rupture following thermal ablation at the First Affiliated Hospital of Dalian Medical University, along with a systematic review of 64 cases from the literature published from January 2019 to May 2025, encompassing an analysis of predisposing factors, time of occurrence, clinical manifestations, imaging features, and treatment strategies associated with nodule rupture.

Among the three cases of nodule rupture following thermal ablation reported at our center, two-dimensional ultrasound and contrast-enhanced ultrasound showed thyroid capsular discontinuity and an extrathyroidal mass with central non-enhancement and peripheral isoenhancement. Case 1 was complicated by abscess formation, with symptom relief achieved through aspiration and drainage; Case 2 experienced nodule rupture secondary to skin burns following ablation performed at an external institution; and Case 3 experienced rupture due to the premature timing of repeat ablation. Both Case 2 and Case 3 achieved complete symptom resolution with conservative management. A systematic review of 64 cases of nodule rupture following thermal ablation revealed that the median time to onset was 28 days postoperatively, 71.9% (46/64) of patients presented with neck pain and 28.1% (18/64) with neck swelling. Ultrasound imaging showed thyroid capsular discontinuity in 95.3% (61/64) of cases. Among the 40 cases with reported rupture type 90.0% (36/40) presented with anterior-type rupture. Additionally, among 58 cases reporting the correlation between initial nodule size and rupture, 86.2% (50/58) had an initial maximum diameter＞2.75 cm. Finally, 89.7% (52/58) of patients initially received conservative management, achieving a complete resolution rate of 50.0% (26/52), while 10.3% (6/58) underwent invasive treatment as the primary intervention.

Nodule rupture following thyroid thermal ablation most frequently occurs in larger nodules and is predominantly characterized by anterior type rupture, with a median time to onset of 28 days postoperatively. Neck pain is the most common clinical manifestation. Two-dimensional ultrasound, in combination with contrast-enhanced ultrasound, plays a critical role in the diagnosis. Conservative treatment is effective in some cases, while invasive treatments can improve overall treatment success.