Image-guided thyroid nodule ablation is a relatively new technique for the management of thyroid disease. Notably, if there has been the correct patient selection and if they are performed in high volume centers and via a standardized technique, image-guided thyroid nodule ablation seems to be safe and effective and it can be used to treat thyroid goiters. However, there is still paucity of level 1 evidences and recommendation comparing ablation to surgical or to other non-surgical treatment modalities. Herein, some technical notes for the thyroid nodule ablation to achieve the critical view of safety are presented. Moreover, an additional remark and appraisal from a surgical point of view is described.