Treatment of Large Cold Benign Thyroid Nodules Not Eligible for Surgery with Percutaneous Ethanol Injection

Abstract

We studied the effect of percutaneous ethanol injection (PEI) in the treatment of cold, cytologically benign, large (>10 mL) thyroid nodules (CBNs) in 41 patients. The end-point of our study was to evaluate the efficacy of PEI on: 1) local symptomatology, assessed by an arbitrary symptom score; and 2) nodule volume and tracheal displacement (at ultrasonography). Follow-up ranged from 12-36 (21 +/- 9) months. Symptom score was significantly reduced (P < 0.01) after 6 months and at the end of the follow-up (2.1 +/- 0.3 vs. 0.2 +/- 0.5 and vs. 0.2 +/- 0.4). A significant (P < 0.01) nodule volume reduction was observed, without differences between solid or mixed CBNs; the reduction was 50% or more in 92.7% of patients. Neither clinical parameters nor pretreatment nodule ultrasonographic features were related to nodule reduction. Disappearance or significant reduction (>0.5 cm) of tracheal displacement was obtained in 61% and in 39% of patients, respectively. One patient experienced prethyroid region edema, pain, and mild fewer, which reversed within 1 week; and one patient had dysphonia, caused by vocal cord palsy, which reversed spontaneously within 1 month. At the end of the follow-up, nodules with just necrotic material at cytology showed a greater (P < 0.05) volume reduction than nodules with residual benign thyroid cells. Our data suggest that PEI is a safe and effective treatment of large CBNs, although sometimes serious side effects do occur.

Long-term outcome following interstitial laser photocoagulation of benign cold thyroid nodules

“…By administring up to three treatments, the median reduction may increase by 33% (5,18,20,22,29). Although easily performed, and recommended for solitary cysts (4,30), PEI has limitations related to ethanol escaping outside the nodule or even the thyroid gland (1,31), and this questions the suitability of PEI, especially in solid nodules (30). In contrast to ethanol, necrosis induced by thermal energy can be delivered in a controlled fashion with none or only minimal damage to the surrounding tissue (16,17).…”

Sonography-Guided Ethanol Ablation of a Remnant Solid Component after Radio-Frequency Ablation of Benign Solid Thyroid Nodules: A Preliminary Study

“…[16][17][18] However, substantial operator experience and a precise US-guided injection may help decrease the incidence of or avoid complications. With the exception of transient neck pain and diffuse glandular hemorrhage, no serious complications of EA occurred in this study.…”

Effect of ultrasound-guided interstitial laser photocoagulation on benign solitary solid cold thyroid nodules – a randomised study

“…Several studies have confirmed that PEI is effective in inducing necrosis and subsequent nodule shrinkage up to 1 year after treatment (7,8,22,23). Although easily performed, PEI has limitations related to ethanol escaping outside the nodule capsule and even the thyroid (5,8,23). In contrast to ethanol, the laser-induced destruction zone and necrotic area can be controlled, resulting in no or minimal damage to the surrounding tissue (16).…”