Percutaneous image-guided thermal ablation is a nonsurgical treatment in benign and malignant thyroid lesions. Laser ablation of thyroid nodules is a minimally invasive procedure to treat benign thyroid lesions including cold nodules or single nodules within a multinodular goiter. The technique consists of the destruction of the tissue by the insertion therein of optical fibers which convey the light energy, causing a complete and irreversible necrosis. In many clinical trials, laser ablation has demonstrated a good efficacy for the shrinkage of benign cold thyroid nodules. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences, or distant metastases. Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.