Although radiofrequency ablation (RFA) was first used as an alternative to conventional thyroid surgery in Asia and Europe around the turn of the millennium, it has only lately gained traction in the United States. Very few studies with large sample sizes have been published in the United States. For this study, researchers analyzed data from 2 hospitals in North America that treated benign thyroid nodules with RFA. Between July 2019 and January 2022, they conducted a prospective, multi-institutional cohort analysis of patients with RFA for thyroid nodules. The patients’ demographics, thyroid nodule sonograms, thyroid function profiles, surgical procedures, complications, and nodule volumes were analyzed at 1, 3, 6, and 12 months post-op. An adjusted multivariate logistic regression analysis identified a sonographic characteristic linked with treatment failure. All told, 233 nodules were accounted for. For  1 month: 54% [interquartile range (IQR): 36%-73%], 3 months: 58% [IQR: 37%-80%], 6 months: 73% [IQR: 51%-90%], and 12 months: 76% [IQR: 52%-90%] (P<0.001). Toxic adenomas were found in 4 cases. At the 3-month follow-up after the procedures, all patients were found to be euthyroid. Though 2 patients experienced brief episodes of hoarseness after the treatment, neither suffered a hematoma nor experienced a nodular rupture. Strong correlations between elastography and volume reduction rate (VRR) were found. Stiff nodules were associated with a lower VRR than soft nodules (odds ratio: 11.64, 95% CI: 3.81-35.53, P<0.05), and mixed elasticity was likewise associated with a lower VRR than pure elasticity (odds ratio: 4.9; 95% CI: 1.62-14.85, P<0.05). Thyroid nodule therapy response was studied at more hospitals than ever before in this massive North American study. With limited potential for complication, RFA is a reliable method for treating thyroid conditions that allow for the maintenance of thyroid function.