SONOGRAPHICALLY MONITORED ALCOHOL INSTILL ATION IN THE TREATMENT OF AUTONOMIC THYROID ADENOMA

In 16 patients with unifocal thyroid autonomy suffering from hyperthyr oidism and in 2 patients and euthyrosis 2-4 ml 96% alcohol was instill ed to destroy the autonomous thyroid tissue while permanently monitori ng the procedure by means of sonography. 17 of the patients were suffe ring from struma nodosa. Localization of the focally autonomous adenom a was possible, together with differentiation against concomitant thyr oid nodes with normal or reduced function, by coinciding the findings obtained via colour Doppler sonography and scintiscanning. In one fema le patient local pain occurred during instillation that had to be alle viated by means of analgetics; there were no other noticeable side eff ects. 12 of 16 patients suffering from hyperthyroidism were euthyrotic 5 weeks after the first alcohol instillation; the thyrostatic dose ha d to be reduced in 4 patients. B-image sonography showed a reduction i n size of the instilled adenomas and echo-poor and partly cystic trans formation Colour Doppler sonography revealed a marked reduction of int ernal vascularisation with preserved marginal vessels. Scintiscan cont rol no longer visualised the autonomic foci (n = 10) or only with redu ced activity (n = 7). Sonographically monitored on-target instillation of alcohol into autonomic thyroid adenoma is an effective, low-risk a nd low-cost procedure that can also be applied to outpatients by physi cians well-versed in colour Doppler sonography and sonographic punctur e technique. Colour Doppler sonographic localization of autonomic foci is methodically mandatory in patients suffering from struma multinodo sa.