Treatment of bengin thyroid nodules with perculaneous ethanol injection

Aim: Percutaneous ethanol injection for treatment of solitary benign thyroid nodules has been introduced since more than a decade. In the present work, we aimed to apply percutaneous ethanol injection [PEI] guided by ultrasound, for a group of patients with solitary benign thyroid nodules to study its efficacy, acceptance by patients, and assessment of clinical, laboratory and ultrasonographic outcomes. Subjects and Twenty-two cases were recruited. They were classified according to thyroid scintiscan and hormonal profile into 3 groups: group I comprised 8 euthyroid patients with toxic nodule, group II which comprised 8 euthyroid patients with cold nodule, and group III included 6 thyrotoxic patients with toxic nodule. All patients were subjected to fine needle aspiration cytology, assessment of serum T3, T4 and sTSH, 99Tc pertechnetate thyroid scanning in addition to clinical and ultrasonographic evaluation. Patients were subjected to injection of sterile 95% ethanol alcohol, under ultrasound guidance without anaesthesia or sedation with a 22-gauge needle using sterile disposable plastic syringes. Dose per injection was calculated to be 20-30% of the nodule volume to achieve a total amount of 1.5 times the nodule volume. Injection was done once per week, and one injection was done in one session. Patients were followed up for 6 months. There was a significant reduction in nodule volume in the three studied groups without any difference between them. For group I, the initial nodule volume was 15.8 +/- 3.1 ml. It became 9.0 +/- 2.39 ml. after 3 months [P 0.000] and at the end of 6 months it became 6.8 +/- 1.3 ml with a net reduction of 59% of the initial nodule volume. For group II the initial nodule volume was 12.5 +/- 1.7 ml. It became 6.8 +/- 1.3 ml after 3 months [P 0.000] and at the end of 6 months it became 5 +/- 0.6 with a net reduction of 60% of the initial nodule volume. For group III, the initial nodule volume was 11.7 +/- 2.4 ml. It became 6.67 +/- 1.6 ml after 3 months [P < 0.005] and at the end of 6 months it became 5.0 +/- 0.9 ml with a net reduction of 54% of the initial nodule volume. For the three groups, there was positive significant correlation between the initial nodule volume and the amount of reduction in size of the nodule [for group I: r 0.99 and P 0.000, for group II: r 0.87 and P < 0.005, while for group III: r 0.9 and P < 0.01]. Comparing the reduction in nodule volume after 6 months follow up in the three studied groups it was not significantly different [F 2.16, P > 0.05]. In the group of toxic patients [group III], thyroid hormone levels at the end of 6 months were all normalized, while for the other patients the thyroid hormone profile was kept within normal without a significant change through the period of follow up. The technique was well accepted by the patients, and the side effect profile was limited to local pain.with variable radiations. Short-term fever was recorded in 4 cases and transient dysphonia was recorded in 3 cases. All reported complications disappeared from a few hours to 3 days. Conclusions: It was concluded that PEI is cheap, convenient, well accepted by patients, effective in inducing nodule shrinkage and in controlling the thyrotoxic state, without inducing hypothyroidism, and free of the known risks of radioiodine or surgery. With all these advantages, PEI is recommended to have its place in the management options of solitary benign thyroid nodules