Resolution of Hyperthyroidism in a Pregnant Woman with Toxic Thyroid Nodule by Percutaneous Ethanol Injection

Cortelazzi, Donatella; Castagnone, D; Tassis, Beatrice; Venegoni, E.; Rivolta, R; Beck‐Peccoz, Paolo

doi:10.1089/thy.1995.5.473

Cited by 12 publications

(8 citation statements)

References 16 publications

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“…Though rare, medical treatment may cause fetal complications. Based on these facts there could be a need for an alternative treatment in pregnant women and so far there has been one report on the successful resolution of overt hyperthyroidism by FEIT in a pregnant woman with a toxic thyroid nodule (25). Ethanol injection of autonomously hyperfunctioning thyroid nodules is inferior to 131I and surgery, and should be reserved for patients who cannot or will not be so treated.…”

mentioning

confidence: 99%

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases

Bennedbæk¹,

Karstrup

Hegedűs³

1997

European Journal of Endocrinology

150

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Relevant English language articles published from 1966 to 1995 regarding ethanol therapy in the treatment of thyroid and parathyroid diseases were identified through a MEDLINE search and manual searches of identified articles. The sclerosing properties of ethanol have been recognized for many years and have offered interventional possibilities in the management of various benign as well as malignant lesions. The mechanism of action of ethanol appears to be related to a direct coagulative necrosis and local partial or complete small vessel thrombosis. Ultrasound-guided percutaneous ethanol injection therapy (PEIT) is rapid and performed on an out-patient basis and has now gained wide acceptance due to the accumulating evidence of the efficacy and safety of this therapeutic tool. Yet, there is a lack of prospective, randomized clinical trials comparing PEIT with 131I therapy or surgery with regard to its effects, especially long-term ones and it should therefore still be considered an experimental procedure. In benign endocrine diseases, PEIT has shown promising results in the treatment of autonomous thyroid nodules, benign solitary cold solid as well as cystic thyroid nodules and parathyroid tumours. Its use in pretoxic and toxic thyroid nodules has been evaluated in several uncontrolled studies, all demonstrating a high success rate in spite of the large number of treatments needed. So far efficacy and cost-effectiveness seem inferior to 131I and surgery. Short-term results of PEIT in benign cystic thyroid nodules are convincing with a high cure rate, but no controlled studies with long-term results are available. Preliminary results suggest that PEIT could become an alternative to surgical excision or levothyroxine therapy in the symptomatic solid cold benign thyroid nodule. Ultrasound-guided PEIT of parathyroid tumours has proven to be a useful method in highly selected patients in whom surgery has been found non-attractive and medical treatment ineffective. However, no prospective randomized trials have been published comparing the results of PEIT in parathyroid tumours with conventional surgical and medical treatments. PEIT has never been tested against standard therapy, but seems inferior to 131I and surgery. Side-effects caused by ethanol injection are generally few and transient and are related to the injection into solid nodules rather than cysts. Ethanol injection into solid profund nodules may seriously jeopardize subsequent surgery because of perinodular fibrosis. As an experimental procedure, not yet evaluated sufficiently, it should be reserved for patients who cannot or will not undergo standard therapy. Caution in routine use is advisable.

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mentioning

confidence: 99%

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases

Bennedbæk¹,

Karstrup

Hegedűs³

1997

European Journal of Endocrinology

150

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“…It is generally accepted that, as in nonpregnant subjects of comparable age, most such nodules are benign (16,17). The vast majority of nodules found during pregnancy are nonfunctioning, although toxic autonomously functioning adenomas have rarely been discovered during pregnancy (18). In recent cytopathological and histological reports 30% to 80% of biopsied nodules have been found to be suspicious for malignancy (16)(17)(18)(19)(20).…”

Section: How Often Is Ntd Found During Pregnancy?mentioning

confidence: 99%

“…The vast majority of nodules found during pregnancy are nonfunctioning, although toxic autonomously functioning adenomas have rarely been discovered during pregnancy (18). In recent cytopathological and histological reports 30% to 80% of biopsied nodules have been found to be suspicious for malignancy (16)(17)(18)(19)(20). Indeed, it has been estimated that papillary or follicular carcinoma may afflict 1 in 1000 pregnancies (21).…”

Section: How Often Is Ntd Found During Pregnancy?mentioning

confidence: 99%

“…Highresolution ultrasound studies in large groups of normal volunteers have suggested that the prevalence of incidentally discovered nodular thyroid disease (NTD) in healthy adults is over 60% (4). However, in the United States during 1999 only 18,100 new cases of thyroid cancer will be diagnosed (5). Given that the prevalence of clinical thyroid cancer in most populations is much less than 1%, the majority of these so-called "thyroid incidentalomas" are obviously benign (6,7).…”

Section: Introductionmentioning

confidence: 99%

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Nodular Thyroid Disease Diagnosed During Pregnancy: How and When to Treat

Hay¹

1999

Thyroid

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“…Nevertheless, TN causing pressure symptoms and/or hyperthyroidism raises concern about appropriate therapy because surgery and general anesthesia pose risks in pregnant women [ 8 ], and the use of thyrostatic agents is not without risk. Although percutaneous ethanol injection therapy (PEI) is a useful alternative to surgery in recurrent thyroid cysts and may have a limited role in the case of solid TN, to the best of our knowledge, there are only two publications focusing on [ 9 ] or mentioning [ 10 ] PEI in the event of pregnancy. Based on this information, we decided to analyze our experiences in this field.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Ethanol Sclerotherapy of Symptomatic Nodules Is Effective and Safe in Pregnant Women: A Study of 13 Patients with an Average Follow-Up of 6.8 Years

Solymosi¹,

Melczer

Szabolcs³

et al. 2015

International Journal of Endocrinology

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Background. Because of the increased risk of surgery, thyroid nodules causing compression signs and/or hyperthyroidism are concerning during pregnancy. Patients and Methods. Six patients with nontoxic cystic, four with nontoxic solid, and three with overt hyperthyroidism caused by toxic nodules were treated with percutaneous ethanol injection therapy (PEI). An average of 0.68 mL ethanol per 1 mL nodule volume was administered. Mean number of PEI treatments for patients was 2.9. Success was defined as the shrinkage of the nodule by more than 50% of the pretreatment volume (V0) and the normalization of TSH and FT4 levels. The average V0 was 15.3 mL. Short-term success was measured prior to labor, whereas long-term success was determined during the final follow-up (an average of 6.8 years). Results. The pressure symptoms decreased in all but one patient after PEI and did not worsen until delivery. The PEI was successful in 11 (85%) and 7 (54%) patients at short-term and long-term follow-up, respectively. Three patients underwent repeat PEI which was successful in 2 patients. Conclusions. PEI is a safe tool and seems to have good short-term results in treating selected symptomatic pregnant patients. Long-term success may require repeat PEI.

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Resolution of Hyperthyroidism in a Pregnant Woman with Toxic Thyroid Nodule by Percutaneous Ethanol Injection

Cited by 12 publications

References 16 publications

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases

Nodular Thyroid Disease Diagnosed During Pregnancy: How and When to Treat

Percutaneous Ethanol Sclerotherapy of Symptomatic Nodules Is Effective and Safe in Pregnant Women: A Study of 13 Patients with an Average Follow-Up of 6.8 Years

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