PURPOSE: Ultrasound (US)-guided thermal ablation (TA) is widely used as a minimally invasive alternative to surgery for symptomatic benign thyroid nodules. Although less invasive, complications occur in up to 4% of cases. This review assessed the incidence of TA-related complications, focusing on prevention and management. MATERIAL AND METHODS: PubMed, Embase, and Cochrane were searched for studies on thyroid TA complications. Eligible studies were in English, included > 100 patients, reported complication rates, and had full text available. Studies with malignant nodules, unclear reporting, or < 100 patients were excluded. Risk of bias was assessed with ROBINS-I and evidence certainty with GRADE. Complications and preventive strategies were summarized. RESULTS: Among 282 screened studies, 11 including 15,333 patients were analyzed. The pooled overall complication rate was 4.3% (range 1.0-8.8%). Post-procedural pain was most common (1.5%, range 0-5%). Major complications were rare (0.16%), while minor complications occurred in 4.2%. Prevention relied on operator training, knowledge of neck anatomy, hydrodissection, trans-isthmic approach, and moving-shot technique. CONCLUSIONS: Thyroid TA is safe, with very low major complication rates, though minor events may occur. Best results require strong anatomical knowledge, ultrasound expertise, and correct technique. Evidence quality remains low with moderate-to-serious risk of bias.