Background High-intensity focused ultrasound (HIFU) is a recent noninvasive technique of treating thyroid nodules. Our study aims to investigate the efficacy and safety of HIFU in treating benign thyroid nodules. Methods This is a retrospective analysis of consecutive patients who underwent HIFU of benign thyroid nodules at our institution from July 2017–2018. All procedures were performed by a single surgeon. Patients were evaluated immediately post-procedure, and at subsequent intervals of 1 week, 1 month, 3 months, and 6 months. The primary endpoint was thyroid nodule volume reduction at 6 months posttreatment. Secondary endpoints were post-procedure local complications. Results Ten patients with 13 thyroid nodules were included. The median follow-up period was 426 days (range 238–573). Mean maximum diameter reduced from 2.6 cm (±0.8) pretreatment to 1.4 cm (±0.7, P  < 0.05) 6 months posttreatment. Mean nodule volume reduced from 5.2 cm 3 (±4.2) pretreatment to 1.5 cm 3 (±1.3 , P  = 0.01) 6 months posttreatment. Mean volume reduction ratio (VRR) at 6 months posttreatment was 63.2% (±22.5, P  < 0.05), with volume reduction of ≥50% in 10 of 13 (76.9%) nodules. Two nodules (15.4%) showed size increases from 4 months posttreatment. No patients experienced local skin burns or hematomas. Mean pain scores were 1.5 (±1.2) immediate post-procedure, 0.8 (±1.5) at 1 week, and 0.6 (±1.2) at 1 month post-procedure, respectively, with no reports of pain beyond 1 month. Only two (20.0%) patients had early, temporary posttreatment voice hoarseness. Conclusion Our study shows HIFU ablation to be efficacious and safe—with significant thyroid nodule volume reductions, and no significant or prolonged local complications.