Percutaneous Ethanol Injection Therapy (Thyroid)

The percutaneous ethanol injection therapy is a method of obliteration ( sclerotherapy ) hot thyroid nodules ( Autonomous adenomas ) by means of alcohol ( ethanol ).

The procedure is an alternative to goiter resection and radioiodine therapy . One advantage is the possibility of outpatient implementation.

Indication and requirement

Therapy with percutaneous injections of ethanol may be indicated ( indicated ) for hot thyroid nodules if neither surgery of the thyroid gland (goiter resection) nor treatment with radioactive ¹³¹ iodine are possible or desirable. This applies, for example, to an increased risk of surgery, multimorbidity , old age, patients requiring dialysis and other contraindications to the other procedures, especially if there are side effects of anti- thyroid therapy .

The prerequisite is that the nodule can be clearly delineated in the thyroid sonography . Sufficient distance from sensitive neighboring structures ( carotid artery , jugular vein , recurrent nerve ) and a node volume of less than 30 ml are required.

execution

The node to be treated is punctured with ultrasound guidance , and a few milliliters of pure alcohol are injected. The ethanol causes a fluid removal of the cells and denaturation of protein . Coagulation necrosis develops over time .

Usually at least four to six doses are given over the course of a week or two.

Successes and side effects

The best results in terms of reducing the size of the hot thyroid nodules and preventing recurrences are seen in those patients who only had small nodules (less than 15 ml) and only had a slight tendency to overactive thyroid gland, at best only subclinical hyperthyroidism . A poor response was found in patients with multifocal autonomy or multinodular goiter .

There are hardly any side effects from experienced practitioners. A transient feeling of pressure, referred pain, and temporary irritation of the laryngeal nerve have been reported.

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Lothar-Andreas Hotze, Petra-Maria Schumm-Draeger. Thyroid diseases. Diagnosis and therapy. Berlin 2003 ISBN 3-88040-002-4