Percutaneous injection of ethanol to treat autonomous thyroid nodules

Abstract

Objective: The aim of this study was to evaluate the efficacy and safety of sonographically guided percutaneous injection of ethanol for treating autonomous thyroid nodules in order to assess that technique's feasibility as an alternative to traditional ablative (radionuclide and surgical) therapies.

Subjects and methods: Thirty-two patients with autonomous thyroid nodules were included in the study: seven had thyrotoxicosis, and 25 were in the pretoxic clinical phase. Ethanol was injected percutaneously on an outpatient basis once or twice a week for a total of three to 10 injections per nodule, mainly depending on the nodule's size. Scintigrams obtained 3 months after the end of treatment were used to assess response to this therapy. The follow-up period was from 3 to 30 months.

Results: Thyroid scintigraphy 3 months after percutaneous injection of ethanol showed complete recovery of function in extranodular tissue in 26 patients (81%), partial recovery in five patients (16%), and no recovery in one patient (3%). In all patients, the volume of the nodules decreased by more than 50% after treatment. In three of five patients in whom scintigraphy showed only partial recovery of function in extranodular tissue, a second percutaneous injection of ethanol was given after 15 months. The therapy was well tolerated, and after a total of 216 injections, no patient had permanent side effects.

Conclusions: Our experience shows that percutaneous injection of ethanol is a practical alternative to traditional treatments for autonomous thyroid nodules and that it is an option for treating pretoxic adenoma.