title: Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules.
abstract: BACKGROUND
  Ultrasound (US)-guided percutaneous ethanol injection (PEI) has been proposed for treatment of benign thyroid nodules (TNs). However, there is no consensus for the optimal amount of ethanol injection, number of applications, and time to re-evaluation in order to achieve maximum volume reduction with minimum adverse effects.
  
  
  OBJECTIVE
  The purpose of the present study was to analyze the effectiveness of an US-guided PEI protocol to treat solid and mixed TNs based on a new target outcome.
  
  
  METHODS
  We performed a prospective study evaluating the results of PEI in 52 patients with benign solid and mixed TNs. The ethanol dose was fixed in 30% of the nodular volume per session. Patients returned 1 month after each session for US re-evaluation. Therapeutic success was defined as volume reduction of at least 30% associated with disappearance of clinical symptoms and a complete esthetic satisfaction reported by the patient.
  
  
  RESULTS
  We performed a mean of 2.8 ± 1.9 PEI sessions, with an average total volume of ethanol injected of 9.1 ± 10.3 ml, and a follow-up time of 10.0 ± 8.7 months. There was a reduction of at least 50% of the initial nodular volume in 33 patients (63.5%). In 11 patients (21.2%), the reduction did not reach 50% (mean reduction of 31 ± 11%), but 6 of them reported esthetically satisfactory results and treatment was stopped. Our therapeutic success rate considering the patients with esthetic improvement was 75%. There were no severe complications.
  
  
  CONCLUSIONS
  Our protocol is effective and safe to treat solid and mixed benign TNs based on our established outcome.
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: João Soares
authors.initials: JS
authors.lastname: Felício
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Antônio Maria Silva
authors.initials: AM
authors.lastname: Conceição
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Flávia Marques
authors.initials: FM
authors.lastname: Santos
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Michelle Masuyo Minami
authors.initials: MM
authors.lastname: Sato
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Fabíola de Arruda
authors.initials: Fde A
authors.lastname: Bastos
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Ana Carolina Contente
authors.initials: AC
authors.lastname: Braga de Souza
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Camila Cavalcante
authors.initials: CC
authors.lastname: Koury
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: João Felício Abrahão
authors.initials: JF
authors.lastname: Neto
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Franciane Trindade
authors.initials: FT
authors.lastname: Cunha de Melo
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Carolina Tavares
authors.initials: CT
authors.lastname: Carvalho
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Thaís Pontes
authors.initials: TP
authors.lastname: Arbage
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Antonio Bentes de Figueiredo
authors.initials: AB
authors.lastname: Junior
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Hana Andrade
authors.initials: HA
authors.lastname: de Rider Brito
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Marcelo Oliveira Mourão
authors.initials: MO
authors.lastname: Júnior
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Fabricio de Souza
authors.initials: Fde S
authors.lastname: Resende
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Amanda Soares
authors.initials: AS
authors.lastname: Peixoto
authors.affiliation: Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará , Belém , Brazil.
authors.forename: Karem Miléo
authors.initials: KM
authors.lastname: Felício
keywords: US-guided; alcoholization; nodule volume reduction; percutaneous ethanol injection; thyroid nodules