Comparison between ethanol sclerotherapy and emptying with injection of saline in treatment of thyroid cysts

Abstract

We compared the results of ethanol sclerotherapy in thyroid cysts with emptying of cysts and instillation of saline. Twenty-six patients with recurrent thyroid cysts were treated with cyst aspiration and subsequent ethanol sclerotherapy. A control group of 44 patients was submitted to cyst aspiration and subsequent injection with isotonic saline; among them 20 had previously been treated with repeated aspirations of the cyst fluid. The patients were followed up clinically and ultrasonically 1 and 12 months after treatment. Cure was defined as the absence of any residual cystic lesion or an ultrasonic cyst volume less than 50% of basal after 12 months from the start of treatment. Cytological study showed all of the lesions to be benign. Of the 44 patients in the saline group 16 (36%) were cured, among whom 6 of 20 had previously been submitted to repeated aspirations. Among the 26 patients treated with ethanol sclerotherapy 20 (77%) were cured. Statistical analysis revealed a significantly higher effectiveness of treatment with ethanol than that with emptying and saline instillation (chi-square, P = 0.002) or with repeated aspiration and saline instillation (chi-square, P = 0.003). Slight pain was observed in two patients treated with saline and five treated with ethanol sclerotherapy. Three patients treated with ethanol sclerotherapy presented severe pain and one transitory hyperthyroidism. We conclude that ethanol sclerotherapy is effective and safe in the treatment of thyroid cysts.

Ultrasound-guided percutaneous ethanol injection of small and medium-sized thyroid cysts with relatively small amounts of ethanol

“…In different studies, the pain was reported in 2.5% to 30% or, in large cysts, even 70% of patients 14,18,21 . Occasionally, temporary vocal fold paralysis and dysphonia or, rarely, transient thyrotoxicosis may occur 22 . In the largest set of 432 complex cysts, Lee and Ahn reported transient localized pain in 32 (7.9%) and temporary vocal fold paralysis in only 3 (0.7%) patients 10 .…”

Long-term Follow-up Sonography of Benign Cystic Thyroid Nodules after a Percutaneous Ethanol Injection: The Incidence of Malignancy-mimicking Nodules

“…Instead of the surgical removal of benign cystic thyroid nodules, several therapeutic methods, such as percutaneous simple aspiration, thyroid hormone suppression therapy, percutaneous tetracycline instillation, or US-guided PEI, have been utilized (14,15). At present, a US-guided PEI has become the first line treatment method for benign cystic or solid thyroid nodules because of its ease and safety (1 8).…”

Injeção percutânea de etanol no tratamento de nódulos tiroidianos sólidos, císticos e autônomos

“…Cistos com diâmetro maior que 4cm ou aspirados hemorrágicos apresentariam maior probabilidade de recorrência (9,10 A mediana de 4 injeções utilizadas nos nossos pacientes com nódulos císticos é maior que de outros trabalhos da literatura, que utilizaram 1 a 2 injeções para tratamento de cistos puros (9,11,30). Este fato deve-se ao número maior de cistos com componente sólido em nossa casuística, o que nos obrigou a um número maior de sessões para a redução do componente sólido dos mesmos.…”

“…Este fato deve-se ao número maior de cistos com componente sólido em nossa casuística, o que nos obrigou a um número maior de sessões para a redução do componente sólido dos mesmos. Contudo, a inclusão dos nódulos mistos não interferiu na percentagem de redução final dos nódulos (92%), quando comparada a outras séries que obtiveram redução entre 72 e 95% (9,11,12,30).…”

“…A IPE apresenta resultados superiores à aspiração simples e à aspiração seguida do uso de outras substâncias esclerosantes no tratamento de cistos tiroidianos (8)(9)(10)(11), causa índice baixo de recidivas e foi sugerida como a primeira alternativa para o tratamento de cistos recorrentes (12), apresentando redução do volume nodular variável de 45,5 a 96,3% e índice míni-mo de efeitos colaterais (13)(14)(15)(16).…”