Thyroid nodules and cysts are common conditions seen in 30–70% of the general population. Larger size, cosmetic concerns and the development of compression symptoms are the commonly used indications for intervention. About 10–20% are large enough to cause compression symptoms. Some patients are averse to surgery because of the ensuing scar or loss of thyroid function. Non-surgical interventions such as percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) have gained popularity over the past 30 years in Europe and Asia due to the avoidance of a visible scar, conservation of thyroid function, outpatient procedure, cost containment, and short recuperation times. PEI is effective for the treatment of predominantly cystic nodules compared to thermal ablations as an alternative to surgery. The equipment requirements are minimal. With careful patient selection, procedural morbidity is trivial. It also has significant cost advantages for patients and the health care systems. Partially cystic nodules may require sequential or concomitant administration of RFA for optimal volume reduction.