The effectiveness if therapy is measured by nodule volume reduction and preservation of normal thyroid function. The international data for nodule reduction has been overwhelmingly favorable for nodule reduction during the immediate months after therapy. We aim for a 60% reduction in volume at 3 months and a 90% volume reduction in one year. The success of the ablation is determined by the amount of energy delivered in each nodule as well as the precision of the application. Expertise in ultrasound guided therapies is a required to perform these challenging procedures.