Injeção percutânea de etanol dirigida pelo ultra-som no tratamento dos nódulos tireóideos

Camargo, Rosalinda; Tomimori, Eduardo

doi:10.1590/s0004-27301998000400009

Cited by 3 publications

(7 citation statements)

References 15 publications

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“…A IPE guiada por ultra-sonografia é tratamento efetivo e seguro para diversas lesões benignas e malignas de diferentes órgãos (7,19,(26)(27)(28)(29). Na década de 80, foi utilizada com o objetivo de tratar cistos renais, adenoma de paratiróide e pequenos carcinomas hepatocelulares (19,30,31).…”

Section: Alcoolização De Nódulo Tiroidianounclassified

“…(32) propuseram o seu uso para o tratamento de nódulos tiroidianos autônomos, obtendo regressão anatômica das lesões e cura da disfunção glandular. Na última década, vários grupos, especialmente europeus, têm confirmado os bons resultados desta terapia, tanto em nódulos tóxicos (6,33,34) como atóxicos e císticos (7,22,36).…”

Section: Alcoolização De Nódulo Tiroidianounclassified

“…Atualmente, o etanol tem sido utilizado como o principal agente esclerosante nos nódulos císticos da tiróide (7).…”

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“…A IPE pode ser uma alternativa aos pacientes portadores de lesões nodulares da tiróide que tenham indicação cirúrgica e que recusam esta forma de tratamento ou que apresentem alto risco cirúrgico (7).…”

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Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide

Lima¹,

Fagundes

Raffaelli³

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOA doença nodular tiroidiana é problema clínico comum, principalmente em regiões com carência de iodo. Esse estudo avaliou a eficácia da injeção percutânea de etanol (IPE) no tratamento de nódulos tiroidianos únicos, múltiplos, sólidos, císticos, de diferentes tamanhos com ou sem disfunção glandular, em região endêmica de bócio. Quarenta e dois pacientes com diagnóstico de bócio colóide ou hiperplasia nodular colóide, na punção biópsia aspirativa por agulha fina (PBAAF), foram selecionados para análise após terem sido submetidos a pelo menos duas IPEs. Os nódulos tiroidianos eram múltiplos (sólidos e ou císticos) em 52,4% dos pacientes, únicos e sólidos ou mistos em 35,7% e únicos e císticos em 11,9%. A redução média dos nódulos após injeção de etanol foi de 58,2% para os únicos e 60,8% nos císticos. ABSTRACT Alcoholization in the Treatment of Thyroid Nodule in Colloid Goiter Endemic Region.Thyroid nodular disease is a common clinical disorder mainly in iodine lacking regions. This study has evaluated the effectiveness of percutaneous ethanol injection (PEI) in the treatment of single, multiple, solid, and cystic thyroid nodules of different sizes with or without glandular dysfunction, in goiter endemic region. Forty-two patients with diagnosis of colloid goiter or colloid nodular hyperplasia in fine-needle aspiration (FNA) were selected for analysis, after having been submitted to at least two PEI. Thyroid nodules were multiple (solid and or cystic) in 52.4% of the patients, single and solid or mixed in 35.7%, and single and cystic in 11.9%. The mean reduction of nodules after ethanol injection was of 58.2% in the single and of 60.8% in the cystic ones. The reduction of the whole thyroid lobe was evaluated in the multiple nodules and it reached 52.4%. The sideeffects were registered only as a consequence of the application discomfort. This study points out that the percutaneous ethanol injection reaching volume mean reductions, varying from 49% to 60%, is a safe, effective, and simple method for the treatment of benign thyroid nodules.

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Section: Alcoolização De Nódulo Tiroidianounclassified

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Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide

Lima¹,

Fagundes

Raffaelli³

et al. 2007

Arq Bras Endocrinol Metab

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“…Despite some controversial results, PEI seems as effective as radioiodine in inducing partial or complete remission of autonomous nodules, with greater reduction in size and a low risk of recurrence and hypothyroidism (10). PEI is also an alternative for patients with nodular lesions with surgical contraindication or high surgical risk (9).…”

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Evaluation of percutaneous ethanol injections in benign thyroid nodules

Perez

Fighera

Miasaki

et al. 2014

Arq Bras Endocrinol Metab

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Objective: The objective of this study was to evaluate the efficacy and safety of percutaneous ethanol injection (PEI) in the treatment of benign thyroid nodules. Subjects and methods: We evaluated 120 patients with benign thyroid nodules. Patients underwent evaluation of serum TSH and free T4, cervical ultrasound, and thyroid scintigraphy (in those with suppressed TSH levels). The application of sterile ethanol 99% was guided by ultrasound, with the injected volume amounting to one-third of the nodule volume. Response was considered complete (reduction of 90%); partial (reduction between 50 and 90%); or none (reduction of < 50%). Autonomous nodules were evaluated for normalization of TSH levels. Results: Among the nodules studied, 30.8% were solid, 56.7% were mixed, 12.5% were cystic, and 21.6% were hyperfunctioning. The initial volume of the treated nodules ranged from 0.9 to 74.8 mL (mean 13.1 ± 12.4 mL). We performed 1-8 sessions of PEI, applying an average of 6.2 mL of ethanol for patient. After 2 years of follow-up, 17% of patients achieved a complete response (94% reduction); 53%, a partial response (70% reduction); and 30%, no response. A reduction in the volume of autonomous nodules was noted in 70% of cases, and 54% had a normalized value of TSH. The main side effect is local pain, lasting less than 24 hours in most cases. Conclusion: This study showed that PEI is a safe and effective procedure for treatment of benign, solid or mixed thyroid nodules. Most cases resulted in significant reduction in nodule volume, with normalization of thyroid function. Arq Bras Endocrinol Metab. 2014;58(9):912-7 Keywords Nodule, thyroid, goiter; percutaneous ethanol injection; sclerotherapy RESUMO Objetivo: O objetivo deste estudo foi avaliar a eficácia e segurança da injeção percutânea de etanol (IPE) no tratamento de nódulos tireoidianos benignos. Sujeitos e métodos: Foram avaliados 120 pacientes com nódulos benignos de tireoide. Todos realizaram dosagens de TSH, T4 livre, ecografia cervical (US) e cintilografia de tireoide (em pacientes com TSH suprimido). A aplicação de etanol estéril a 99% foi guiada por US e o volume de etanol injetado correspondeu a um terço do volume nodular calculado. A resposta foi considerada completa (redução de 90%); parcial (redução entre 50 e 90%) ou ausência de resposta (redução menor que 50%). Nos nódulos autônomos, foi avaliada a normalização do TSH. Resultados: Entre os nódulos estudados, 30,8% eram sólidos, 56,7% eram mistos, 12,5% eram císticos e 21,6%, nódulos hiperfuncionantes. O volume inicial dos nódulos tratados variou de 0,9 a 74,8 mL (média 13,1 ± 12,4 mL). Foram realizadas de 1 a 8 sessões de IPE (média 2,8), com aplicação média de 6,2 mL de etanol por paciente. Após dois anos de seguimento, 17% dos pacientes obtiveram resposta completa (redução de 94%), 53% obtiveram resposta parcial (redução de 70%) e 30% não responderam. Houve redução de volume nos nódulos autônomos em 70% dos casos, e 54% normalizaram o valor do TSH. Os efeitos colaterais registrados foram decorr...

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Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules

et al. 2016

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ContextUltrasound (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.ObjectiveThe 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.Patients and methodsWe 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.ResultsWe 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.ConclusionOur protocol is effective and safe to treat solid and mixed benign TNs based on our established outcome.

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Injeção percutânea de etanol dirigida pelo ultra-som no tratamento dos nódulos tireóideos

Cited by 3 publications

References 15 publications

Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide

Alcoolização de nódulo tiroidiano em região endêmica de bócio colóide

Evaluation of percutaneous ethanol injections in benign thyroid nodules

Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules

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