Ultrasound-guided alcohol instillation in treatment of autonomous thyroid adenoma

Abstract

In 16 patients with unifocal thyroid autonomy suffering from hyperthyroidism and in 2 patients and euthyrosis 2-4 ml 96% alcohol was instilled to destroy the autonomous thyroid tissue while permanently monitoring the procedure by means of sonography. 17 of the patients were suffering from struma nodosa. Localization of the focally autonomous adenoma was possible, together with differentiation against concomitant thyroid nodes with normal or reduced function, by coinciding the findings obtained via colour Doppler sonography and scintiscanning. In one female patient local pain occurred during instillation that had to be alleviated by means of analgetics; there were no other noticeable side effects. 12 of 16 patients suffering from hyperthyroidism were euthyrotic 5 weeks after the first alcohol instillation; the thyrostatic dose had to be reduced in 4 patients. B-image sonography showed a reduction in size of the instilled adenomas and echo-poor and partly cystic transformation. Colour Doppler sonography revealed a marked reduction of internal vascularisation with preserved marginal vessels. Scintiscan control no longer visualised the autonomic foci (n = 10) or only with reduced activity (n = 7). Sonographically monitored on-target instillation of alcohol into autonomic thyroid adenoma is an effective, low-risk and low-cost procedure that can also be applied to outpatients by physicians well-versed in colour Doppler sonography and sonographic puncture technique. Colour Doppler sonographic localization of autonomic foci is methodically mandatory in patients suffering from struma multinodosa.