[The treatment of solitary thyroid nodules in non-toxic goiter with 96% ethanol injections].
40 patients (39 women and 1 man) aged 13-66 years (mean 35.9 years) with solitary benign non-toxic thyroid nodule confirmed by clinical and hormonal examination, ultrasonography and fine needle aspiration biopsy, were treated with intranodular percutaneous 96% ethanol injection, performed under ultrasound guidance. There were 34 patients with solid nodule (including 4 patients) with solitary nodule in recurrent goitre after thyroidectomy) and 6 patients with cyst. The nodules were 7-60 mm (mean 31 mm) in diameter. 1 ml of ethanol was instilled per 1 cm3 of nodule tissue. 1-5 (mean 2.6) sessions were conducted at one month intervals. The early follow-up evaluation of the results (the evaluation of nodule size by means of clinical and ultrasound examination) was performed after 6 months, and the long-term one after 2 years since the last injection. A morphological evaluation was conducted according to the following scale: 1--nodule disappearance, 2--cicatricial nodule (solid structure in the ultrasonography and less than 0.5 cm in diameter), 3--nodule smaller by [symbol: see text] 50% of initial dimensions, 4--nodule smaller by < 50% of initial dimensions. A final follow-up evaluation revealed: nodule disappearance in 15 (37.5%) patients (Group 1), cicatricial nodule in 10 (25%) patients (Group 2), nodules smaller by [symbol: see text] 50% of initial dimensions in 7 (17.5%) patients (Group 3) and nodules smaller by < 50% of initial dimensions in 8 (20%) patients (Group 4). The results in Group 1 and 2 were defined as good (25 patients--62.5%), in Group 3 as satisfactory (17.5%) and in Group 4 as bad. The results of treatment of cysts and nodules in recurrent goitre were good or satisfactory. The following complications were observed: 1) pain during and after the injection in 29 (72.5%) patients, 2) subfebrile body temperature ap to 38 degrees C in 4 (10%) patients and fever up to 39 degrees C on the 1-st day after the injection in 2 (5%) patients, 3) ecchymosis in 1 (2.5%) patient, 4) temporary dysphonia in 2 (5%) patients, 6) temporary unilateral vocal cord paralysis and temporary Horner syndrome in 1 (2.5%) patient. It seems that percutaneous ethanol injection can be useful treatment method of solitary benign non-toxic thyroid nodules, both cysts and solid nodules, in patients who do not consent to surgical treatment or with contraindications to an operation.
Bartos
M
M
Kliniki Chirurgii Endokrynologicznej i Ogólnej Akademii Medycznej w Lodzi.
Pomorski
L
L
Narebski
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006042:Goiter / Q000150:complications*; D006801:Humans; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D016606:Thyroid Nodule / Q000150:complications / Q000188:drug therapy*
D000891:Anti-Infective Agents, Local; D000431:Ethanol