A Rare Complication following Thyroid Percutaneous Ethanol Injection: Plummer Adenoma

Abstract

Percutaneous ethanol injection (PEI) is a technique used only for benign thyroid nodules, cystic or mixed cystic-solid with a large fluid component. It is a quite low-cost, safe, and outpatient method of treatment. Rare and severe complications have been described after PEI: jugular vein thrombosis and severe ethanol toxic necrosis of the larynx combined with necrotic dermatitis. Moreover, only four thyrotoxicosis cases due to Graves' disease have been reported. We report a case of 58-year-old female with a voluminous thyroid cystic nodule, occupying almost the entire left thyroid lobe. Our patient had already performed surgical visit and intervention of thyroidectomy had been proposed to her, which she refused. At baseline, our patient has a normal thyroid function with negative autoantibodies. According to the nodular structure, intervention of PEI has been performed with a significant improvement of compressive symptoms and cosmetic disorders. About 30 days after treatment, there was a significant volume reduction, but patient developed an acclaimed symptomatic thyrotoxicosis. After ruling out several causes of hyperthyroidism and according to the thyroid scintigraphy findings, we made the diagnosis of Plummer adenoma. To our knowledge, our patient is the first case of Plummer adenoma following PEI treatment of nontoxic thyroid nodule.

Interventional radiology of the thyroid gland: critical review and state of the art

“…More severe but rare complications include ethanol-related larynx or skin necrosis, Graves' disease, Graves' orbitopathy, Horner's syndrome. One case of Plummer adenoma has also been described in literature (36,40,(50)(51)(52)(53).…”

The Comparison of Efficacy and Safety between Radiofrequency Ablation Alone and Ethanol Ablation Followed by Radiofrequency Ablation in the Treatment of Mixed Cystic and Solid Thyroid Nodule

“…RFA is a thermal ablation technique that causes tissue necrosis and shrinkage through high-frequency alternating electric currents ( 5 ). EA causes microvascular thrombosis, cell dehydration, and hemorrhagic infarction of thyroid nodules due to ethanol retention ( 6 7 ). EA has shown excellent efficacy and is recommended as the first-choice ablation technique, particularly for treating cystic or predominantly cystic thyroid nodules ( 8 ).…”

Ethanol Ablation as a Treatment in a Low-Risk Follicular Thyroid Cancer: A Case Report

“…Ethanol has been used therapeutically for decades in various indications such as an antiseptic, an antidote for methanol or ethylene glycol intoxication, alcohol withdrawal syndrome, and also as an ablating, sclerosing, or embolizing agent [4]. When ethanol is injected into cystic thyroid nodules, it promotes cellular dehydration and protein denaturation, resulting in reactive fibrosis [5]. In oncology, ethanol has proven its efficacy in treating various types of cancer, including hepatocellular carcinoma, renal cell carcinoma, and lately recurrent malignant thyroid cancers when the patients presented with high surgical risk or refused surgery [4].…”