The thyroid gland sits in a crowded and complex area of the neck, surrounded by multiple critical structures including the trachea, esophagus, laryngeal nerves, and carotid sheath. Any ablative interventions on the gland itself or in the surrounding central neck area can be highly morbid if not performed by interventionalists with sound anatomic knowledge, strong technical skills, and appropriately chosen equipment. General considerations pertaining to vital structures protection during ablative treatments are presented in this chapter, followed by a discussion on specific vital structures.