Percutaneous Ethanol Injection (PEI): What Is Its Role in the Treatment of Benign Thyroid Nodules?

Objective The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7

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Evaluation of Ethanol Injection, Radiofrequency Ablation, and Levothyroxine Therapy in the Management of Benign Thyroid Nodules

10.21203/rs.3.rs-94756/v1 ◽

2020 ◽

Author(s):

Alireza Arefzadeh ◽

hossein ghanaati ◽

Mahsa Alborzi Avankai ◽

Alireza Abrishami ◽

Hamidreza Niazkar ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Treatment Group ◽

Thyroid Nodules ◽

Volume Reduction ◽

The Other ◽

Single Session ◽

Ethanol Injection ◽

Injection Group ◽

Benign Thyroid Nodules ◽

Benign Thyroid

Abstract Background: Thyroid nodules are a common clinical finding. Even though there are various accepted treatments for the benign thyroid nodules, there are alternative methods for managing these patients with fewer expenses and also minimum complications. This study aims to compare the volume decline of radiofrequency (RF) ablation and single-session ethanol ablation (EA) and the effects of levothyroxine therapy for benign thyroid nodule treatment.Materials: In this clinical trial, 90 patients with benign thyroid nodules in different centers in Tehran, Iran, from December 6, 2018, to December 6, 2019, were included. Patients who had met the inclusion criteria were selected and randomly allocated into three groups (each of 30) of a single session of radiofrequency ablation (Group 1), a single session of ethanol injection (Group 2), or a 6-month LT4 treatment (Group 3). Thyroid tests, including TSH, T4, T3, anti-TPO, T3RU, and serum Calcitonin level, were recorded at baseline and again at 1, 3, and six months. Nodule volume was also assessed through sonography at baseline and the other checkpoints.Results: The mean volume reduction after 6 months of intervention for ethanol injection group, radiofrequency ablation group, and LT4 treatment group were 72.2%, 83.4%, and 21.8%, respectively. There was a significant relationship between mean volume reduction and months (1, 3, and six) (P<0.001).Conclusions: Although radiofrequency ablation therapy is the best modality for managing benign thyroid nodules in our study, it is more expensive than the other modalities despite comparable therapeutic effects.

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Ultrasound Guided Percutaneous Ethanol Ablation of Benign Thyroid Nodule: A Study From a Tertiary Hospital in Eastern India

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1784 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A873-A873

Author(s):

Arjun Baidya ◽

Saba Faiz ◽

Ram Chandra Bhadra

Keyword(s):

Thyroid Nodule ◽

Thyroid Nodules ◽

Response Rate ◽

Percutaneous Ethanol Injection ◽

Ultrasound Guided ◽

Ethanol Ablation ◽

Ethanol Injection ◽

Benign Thyroid Nodule ◽

Benign Thyroid

Abstract Introduction: Ultrasound guided percutaneous ethanol injection (PEI) of benign thyroid nodule is an easy and effective procedure particularly in cystic and predominantly cystic nodule. Aims: To evaluate efficacy and safety of PEI in managing purely cystic and mixed cystic and solid thyroid nodules. Materials and Methods: Patients of either sex presented with solitary purely cystic benign thyroid nodule, solitary benign mixed with predominantly cystic (>50% of total volume) thyroid nodule, solitary benign mixed with predominantly solid (>50% of total volume) thyroid nodule, solitary solid thyroid nodule were included in this study. Patients who had a nodule BETHESDA 3 and above, pregnancy, patients with critical or terminal illness, patients with other malignancies, multinodular lesions of thyroid, patients with raised T3, T4 and/ or suppressed TSH level were excluded from the study. One hundred sixty patients presenting with thyroid nodule were initially evaluated with thyroid function test and USG. Only those patients with euthyroid solitary thyroid nodules are subjected for fine needle aspiration (FNA). Nodules under BETHESDA 2 are considered for US guided percutaneous ethanol injection (PEI). One hundred twenty-three patients were excluded because of various reasons. Finally ethanol ablation was done in 37 patients. Benign, purely cystic and mixed thyroid nodules were aspirated under ultrasonography guidance. Sterile absolute alcohol (99.99%) (50% of volume aspirated/ maximum 10 ml) was injected and reviewed after 2, 5and 7 months. In case of solid nodule alcohol (50% of nodule volume) was injected. A reduction in volume is calculated at each follow up visit. An adequate response is considered as ≥50 percent reduction in size from baseline after 7 months. If the reduction is <50%, then a second session of absolute ethanol injection is given. Again, patients were similarly followed up after 2, 5 and 7 months. Results: Thirty seven patients underwent PEI. Thirty three patients were considered for final analysis (4 lost to follow up). Response rate of PEI for purely cystic nodule was 100.0% and the overall response rate for mixed nodule was 53.57%. None of the solid nodule responded to PEI even after second session. Among the responder in the mixed nodules, 93.33% responded after first session of PEI. Minor complications like headache occurred in 54.1% patients in the first session. Transient pain at injection site were complained by 86.5% and 37.8% patients in the first and second session respectively. Nausea and vomiting were complained by 18.9% and 16.2% patients in the first and second session respectively. Conclusions: PEI is an effective and safe for purely cystic and mixed thyroid nodules. It is a relatively safe and less invasive procedure from management of benign solitary cystic and mixed thyroid nodules.

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