Objective: To explore the effects and prognosis of radiofrequency ablation (RFA) under color Doppler ultrasound guidance in the treatment of benign thyroid nodules. Methods: 146 benign thyroid nodules patients were all treated with RFA under color Doppler ultrasound guidance. The symptoms scores, signs scores, thyroid function, changes of thyroid nodules and prognosis of patients were observed before and after surgery. Results: 1 year after surgery, the symptoms scores and signs scores of patients were all lower than that before surgery remarkably (P<0.05). The free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH) of patients 1 year after surgery had no statistically significant difference compared with that before surgery (P>0.05). Compared with that before surgery, the mean maximum diameter of nodules and nodules volume at 1 month, 1 year, 2 years and 3years after surgery reduced remarkably (P<0.05). Compared with that 1 month after surgery, the volume reduction rate (VRR) at 1 year, 2 years and 3years after surgery increased remarkably (P<0.05). Follow-up for 3 years, the cure rate of 146 patients was 9.5% (14/146), the effective rate was 100% (146/146), and no case recurred. Conclusions: RFA under color Doppler ultrasound has significant long-term effects and good prognosis in the treatment of benign thyroid nodules, thus it is worthy of clinical promotion.