Fn. Bennedbaek et al., PERCUTANEOUS ETHANOL INJECTION THERAPY IN THE TREATMENT OF THYROID AND PARATHYROID DISEASES, European journal of endocrinology, 136(3), 1997, pp. 240-250
Relevant English language articles published from 1966 to 1995 regardi
ng ethanol therapy in the treatment of thyroid and parathyroid disease
s were identified through a MEDLINE search and manual searches of iden
tified articles. The sclerosing properties of ethanol have been recogn
ized for many years and have offered interventional possibilities in t
he management of various benign as well as malignant lesions, The mech
anism of action of ethanol appears to be related to a direct coagulati
ve necrosis and local partial or complete small vessel thrombosis. Ult
rasound-guided percutaneous ethanol injection therapy (PEIT) is rapid
and performed on an out-patient basis and has now gained wide acceptan
ce due to the accumulating evidence of the efficacy and safety of this
therapeutic tool. Yet, there is a lack of prospective, randomized cli
nical trials comparing PEIT with I-131 therapy or surgery with regard
to its effects, especially long-term ones and it should therefore stil
l be considered an experimental procedure. In benign endocrine disease
s, PEIT has shown promising results in the treatment of autonomous thy
roid nodules, benign solitary cold solid as well as cystic thyroid nod
ules and parathyroid tumours. Its use in pretoxic and toxic thyroid no
dules has been evaluated in several uncontrolled studies, all demonstr
ating a high success rate in spite of the large number of treatments n
eeded. So far efficacy and cost-effectiveness seem inferior to I-131 a
nd surgery. Short-term results of PEIT in benign cystic thyroid nodule
s are convincing with a high cure rate, but no controlled studies with
long-term results are available. Preliminary results suggest that PEI
T could become an alternative to surgical excision or levothyroxine th
erapy 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-attractiv
e and medical treatment ineffective. However, no prospective randomize
d trials have been published comparing the results of PEIT in parathyr
oid tumours with conventional surgical and medical treatments. PEIT ha
s never been tested against standard therapy, but seems inferior to I-
131 and surgery. Side-effects caused by ethanol injection are generall
y few and transient and are related to the injection into solid nodule
s rather than cysts. Ethanol injection into solid profund nodules may
seriously jeopardize subsequent surgery because of perinodular fibrosi
s. As an experimental procedure, not yet evaluated sufficiently, it sh
ould be reserved for patients who cannot or will not undergo standard
therapy. Caution in routine use is advisable.