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Percutaneous Ethanol Injection of Large Autonomous Hyperfunctioning Thyroid Nodules¹

¹ From the Ultrasound Service, D. Cotugno Hospital, via Roma 8, 80059 Torre del Greco (Na), Italy. From the 1997 RSNA scientific assembly. Received February 9, 1998; revision requested March 3; final revision received April 15, 1999; accepted July 1. Address reprint requests to L.T. (e-mail: assanui@tin.it).

PURPOSE: To verify the effectiveness of percutaneous ethanol injection (PEI) in the treatment of large (>30-mL) hyperfunctioning thyroid nodules.

MATERIALS AND METHODS: Twelve patients (eight women, four men; age range, 26–76 years) with a large hyperfunctioning thyroid nodule (volume range, 33–90 mL; mean, 46.08 mL) underwent PEI treatment under ultrasonographic (US) guidance. US was used to calculate the volume of the nodules and to assess the diffusion of the ethanol in the lesions during the procedure. When incomplete necrosis of the nodule was depicted at scintigraphy performed 3 months after treatment, additional PEI sessions were performed.

RESULTS: Four to 11 PEI sessions (mean, seven) were performed in each patient, with an injection of 3–14 mL of 99.8% ethanol per session (total amount of ethanol per patient, 30–108 mL; mean, 48.5 mL). At scintigraphy after treatment in all patients, recovery of extranodular uptake, absence of uptake in the nodule, and normalization of thyroid-stimulating hormone (thyrotropin) levels were observed. In all patients, US showed volume reductions of 30%–50% after 3 months and 40%–80% after 6–9 months. Side effects were self-limiting in all patients. During the 6–48-month follow-up, no recurrence was observed.

CONCLUSION: PEI is an effective and safe technique for the treatment of large hyperfunctioning thyroid nodules.

Index terms: Alcohol ablation, 273.1269 • Interventional procedures, 273.1269, 273. 522, 273.529 • Thyroid, hyperthyroidism, 273.522, 273.529 • Thyroid, US, 273.12981, 273.12983, 273.12986 • Ultrasound (US), guidance, 273.12981, 273.12986

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