Percutaneous ethanol injection of autonomous thyroid nodules with a volumelarger than 40 ml: Three years of follow-up

AIM: Autonomous thyroid nodules are conventionally treated by surgery or ra dioiodine. Percutaneous ethanol injection is a recognized alternative appro ach. An assessment of the long-term success and safety was conducted. MATERIALS AND METHODS: Thirty-four patients (seven men and 27 women; age ra nge: 32-80 years; mean: 56 +/- 13 years) with an autonomous thyroid nodule (ATN) > 40 ml (volume range 41-180 ml; mean: 63.6 +/- 34.5 ml) were treated with ultrasound-guided percutaneous ethanol injection (PEI). All patients were hyperthyroid with increased radionuclide uptake in the nodule at scint igraphy. Serial serum (free T3, free T4 and thyroid-stimulating hormone (TS H)) and ultrasound studies were performed at 3, 6, 12, 18, 24 and 36 months after the first PEI session. Scintigraphy was performed before treatment a nd I month after the serum TSH became detectable or alternatively after 6 m onths, even if the TSH was still undetectable. RESULTS: Each patient had 1-11 sessions of PEI, with an injection of 3-14 m l of ethanol per session (total amount of ethanol per patient: 20-125 ml). Within 3 months from the end of the treatment, the recovery of extranodular uptake on isotope scan and the normalization of TSH levels were observed i n 30/34 patients. A reduction (average: 62.9%) of nodule volume was recorde d in all patients and only 4/ 34 patients were refractory to PEI. The respo nsiveness of ATN to PEI appeared to be dependent on the initial nodule volu me (3/4 failures in patients had nodule volumes > 60 ml). Side-effects were always self-limiting. During follow-up (6-36 months) no recurrence was obs erved. CONCLUSION: In conclusion, the treatment of ATN > 40 ml with PEI would appe ar to be a valid alternative approach to traditional methods of treatment. It is safe, well tolerated and inexpensive. Its acceptability when compared with surgery and radiodioine has still to be assessed. (C) 2001 The Royal College of Radiologists.