Treatment of thyroid cysts by aspiration and injection of sclerosant.

Ultrasound guided percutaneous ethanol injection in the treatment of cystic thyroid nodules

“…Percutaneous fine r.eedle aspiration (FNA) allows cytological diagnosis of cystic thyroid nodules; moreover, it may be of therapeutic value since it can reduce the size of the cysts. To reduce the high rate of relapse after FNA, both suppressive levothyroxine therapy (McCowen et al, 1980) and percutaneous injection of several sclerosant agents (Sykes, 1981;Ryan et al, 1982;Treece et al, 1983;Porenta & Fettich, 1985;Edmonds & Tellez, 1987;Hegedus et al, 1988;Rozman et al, 1989;Yasuda et al, 1992) have been proposed with conflicting results. To reduce the high rate of relapse after FNA, both suppressive levothyroxine therapy (McCowen et al, 1980) and percutaneous injection of several sclerosant agents (Sykes, 1981;Ryan et al, 1982;Treece et al, 1983;Porenta & Fettich, 1985;Edmonds & Tellez, 1987;Hegedus et al, 1988;Rozman et al, 1989;Yasuda et al, 1992) have been proposed with conflicting results.…”

“…However, frequent reaccumulation of cyst fluid has been reported (Miller et al, 1974;Jensen & Rasmussen, 1976;Galvan & Maurer, 1977). To reduce the high rate of relapse after FNA, both suppressive levothyroxine therapy (McCowen et al, 1980) and percutaneous injection of several sclerosant agents (Sykes, 1981;Ryan et al, 1982;Treece et al, 1983;Porenta & Fettich, 1985;Edmonds & Tellez, 1987;Hegedus et al, 1988;Rozman et al, 1989;Yasuda et al, 1992) have been proposed with conflicting results.…”

“…No local complications were reported. On the other hand, percuta-neous instillation into the cysts of sclerosant agents, such as sodium tetradecyl sulphate and hydroxy-polyethoxy-dodecan (Porenta & Fettich, 1985;Edmonds & Tellez, 1987) or tetracycline (Ryan et al, 1982;Treece et af., 1983;Hegedus et al, 1988), has given conflicting results. However, the actual therapeutic effectiveness of the procedure is hampered by the frequent (15-60% of cases) near-complete recurrence of the fluid component of the nodule (Miller et af., 1974;Jensen & Rasmwsen, 1976;Galvan C Maurer, 1977).…”

“…Thyroid hormone administration was reported to be ineffective (McCowen et al, 1980); moreover, suppressive therapy may be associated with long-term side-effects (Forfar e f al., Ribot et ul., 1990; Taelman e f uf., 1990). On the other hand, percuta-neous instillation into the cysts of sclerosant agents, such as sodium tetradecyl sulphate and hydroxy-polyethoxy-dodecan (Porenta & Fettich, 1985;Edmonds & Tellez, 1987) or tetracycline (Ryan et al, 1982;Treece et af., 1983;Hegedus et al, 1988), has given conflicting results. Indeed, the results of the only randomized trial (Hegedus et al, 1988) demonstrated that tetracycline injection was no more effective than isotonic saline in treating thyroid cysts.…”

Commentary

“…The finding of inflammatory cells should be followed by culture of the aspirate to establish the nature of the infection. Infective lesions in the thyroid may respond to treatment by repeated aspiration and antibiotics alone (Edmonds & Tellez, 1987) and provided there is not an adjacent source of infection, allow cure without recourse to surgery.…”