Sonographically guided percutaneous ethanol treatment of a symptomatic complex nodule with a large cystic component in a patient with thyroid hemiagenesis

Abstract

Thyroid hemiagenesis is a rare anomaly that is usually discovered incidentally during the evaluation of unrelated thyroid disorders. We present the case of a patient with hemiagenesis of the left thyroid lobe and a large, recurrent, symptomatic complex nodule with a large cystic component that occupied most of the right lobe. She had previously undergone multiple unsuccessful aspirations of the cyst. The patient was successfully treated with an intranodular injection of ethanol under sonographic guidance. The success of this procedure resulted in the resolution of symptoms and avoidance of surgical resection of the right lobe, with resulting hypothyroidism. We recommend that ethanol injections be considered for treatment of symptomatic cystic or benign solid nodules in patients with thyroid hemiagenesis and in those who have undergone hemithyroidectomy and have symptomatic nodules.

Left Thyroid Lobe Hemiagenesis with Hyperthyroidism: Report of a Case

“…[3][4][5][6] If a nonfunctional lobe is found during scintigraphy, ultrasonographic examination should be done to determine if there is thyroidal hemiagenesis. 3,7 We present this case report to emphasize the importance of establishing a correct diagnosis Reprint patient. 3,6 A slight predominance of hyperthyroidism was also reported, as in our patient.…”

“…A genetic tendency among siblings was also reported, 19,20 but we could not convince the family members of our patient to undergo ultrasonographic examination. 7 Differentiating between suppressed thyroid tissue and thyroid hemiagenesis can be difficult, although Tc-99m pertechnetate radionuclide angiography can be done in patients with unilateral negative radionuclide uptake, since it is simple, safe, and gives accurate results. 3 Radionuclide angiography was not done in our patient because it was not part of our routine workup.…”

“…3,6 A slight predominance of hyperthyroidism was also reported, as in our patient. 1,3,8 Follicular and papillary neoplasms, [3][4][5][6][7][8][9][10][11] Graves' disease with thyrotoxicosis, 3,9,12,13 hypothyroidism, 1,3 hyperparathyroidism, 14 Hashimoto's thyroiditis, 15 lymphocytic thyroiditis, 16 sublingual thyroid, 17 and thyroglossal duct cyst 18 are among the reported accompanying disorders. The incidence of thyroid hemiagenesis is uncertain, since some patients are in a euthyroid state without any abnormalities; hence, there could be many cases of undiagnosed thyroid hemiagenesis.…”