Benign Cystic Thyroid Research Articles

077. Ethanol Ablation as Therapeutic Options for Benign Thyroid Cyst: A Literature Review

Background: Minimally invasive management of symptomatic cystic thyroid nodules has become common practice. Ethanol ablation for benign thyroid cysts has been performed since 1990. Various consensus guidelines have been developed, but a more detailed review regarding the safety and outcomes of this procedure is still needed. This study aims to identify and summarize the indications, techniques, outcomes, and complications of ethanol ablation for benign thyroid cysts through a literature search and review using PubMed and EMBASE. Results: A database search using specific keywords identified a total of 134 titles. Screening of titles and abstracts with inclusion and exclusion criteria excluded 124 titles. After removing duplicates, checking full-text availability, and study eligibility, 7 studies met the criteria. Clinical evaluations, indications, techniques, outcomes, and complications were extracted from each study. Conclusion: Ethanol ablation (EA) is a safe, repeatable, cost-effective procedure that can be performed in an outpatient setting. It has transient side effects and complications, most of which resolve spontaneously. Thus, EA can be considered a first-line non-surgical treatment for benign thyroid cysts and predominantly cystic thyroid nodules (PCTN).

Effect of Ultrasound-Guided Ethanol Ablation in Management of Benign Cystic Thyroid Nodules

Effect of Ultrasound-Guided Ethanol Ablation in Management of Benign Cystic Thyroid Nodules

Ultrasound-Guided Percutaneous Ethanol Ablation in Cystic and Predominantly Cystic Thyroid Nodules

Abstract Background thyroid cystic and predominantly cystic nodules are frequent among the general population. Some can increase in size with time and cause pressure and cosmetic symptoms. Their standard line of treatment is usually simple aspiration which was found to have high recurrence rate. Recurrent cystic thyroid nodules were considered for surgical removal which had many serious adverse effects. Aim of the Work to evaluate the efficacy, and safety of ultrasound guided percutaneous ethanol injection in cystic and predominantly cystic thyroid nodules in patients referred to Interventional Radiology Unit; Ain Shams University Hospitals. Patients and Methods The study was conducted at the Interventional Radiology Unit; Radiology Department, Ain Shams University Hospitals and conducted 20 patients with cystic thyroid nodules. Results The present study concludes that EA should be considered as the first option for the treatment of pure cysts and predominantly cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects. Conclusion EA should be considered as the first option for the treatment of benign cystic thyroid nodules, especially pure cystic nodules that are not treated with simple aspiration. EA of thyroid cysts having solid component has limited therapeutic effect and may require multiple sessions. Unlike surgery, EA is a safe procedure that is easy to repeat, is inexpensive, can be performed easily on an outpatient basis, and has only transient side effects.

Analysis of clinical and ultrasound results after treatment with percutaneous ethanol injection in benign cystic thyroid nodules

Analysis of clinical and ultrasound results after treatment with percutaneous ethanol injection in benign cystic thyroid nodules

Percutaneous ethanol sclerotherapy for the treatment of benign cystic thyroid nodules: A 5 year-experience at a tertiary care hospital

Percutaneous ethanol sclerotherapy for the treatment of benign cystic thyroid nodules: A 5 year-experience at a tertiary care hospital

Radiofrequency vesus ethanol ablation for single-session treatment of benign cystic thyroid nodules: a short-term retrospective study

Radiofrequency vesus ethanol ablation for single-session treatment of benign cystic thyroid nodules: a short-term retrospective study

Ultrasound-Guided Ethanol Ablation for Thyroglossal Duct Cyst: A Review of Technical Issues and Potential as a New Standard Treatment.

The thyroglossal duct cyst (TGDC) is the most common congenital neck mass, accounting for 70-75% of all congenital neck masses. Although the Sistrunk operation has been used as a standard of treatment, it is accompanied by a considerable surgical burden, including the need for general anesthesia, a visible surgical scar on the neck surface, and postoperative complications. Ultrasound-guided ethanol ablation (US-EA) is a minimally invasive and office-based technique that is widely used as a non-surgical treatment for several benign cystic lesions, particularly benign thyroid cysts. Recently, US-EA has also been gaining popularity as a good alternative for TGDC treatment, which is associated with high feasibility, a high safety profile, and favorable treatment outcomes. To our best knowledge, seven studies on the use of EA as a primary treatment option for TGDC have been published since 2011. Although these studies have reported promising results, there is a lack of consensus on several issues regarding the application of EA for TGDC, particularly its detailed techniques and role as a primary treatment. This article aims to provide a comprehensive review of EA for TGDC, addressing technical issues and its possible role as a new standard of treatment for TGDC.

Sonographic changes in the thyroid gland after sclerotherapy with doxycycline can be mistaken for thyroid cancer

BackgroundThe literature considers sclerotherapy to be a safe and effective treatment for benign thyroid cysts. No subsequent diagnostic problems have been reported as a complication. We report the occurrence of focal inflammation after said therapy, mimicking a thyroid malignancy.Case presentationWe report a case of a young male with a solitary strongly suspicious lesion in the thyroid. The patient had undergone prior sclerotherapy of a thyroid cyst with Doxycycline. The lesion appeared to be a focal area of inflammation and thus iatrogenic in nature. Systemic use of doxycycline is known to sometimes cause a non-immune chemical thyroiditis, dubbed as black thyroid due to the intense black discoloration of the thyroid. It might be that the instillation of doxycycline was responsible for a similar, more localized area of thyroiditis.ConclusionsFor the work-up of a solitary suspicious thyroid lesion, the medical history of the patient should always be considered. In case of prior ipsilateral sclerotherapy, a reactive inflammatory response may mimic thyroid malignancy. A fine needle aspiration should be performed to exclude thyroid cancer. Treatment is not necessary; the process appears to be self-limiting as evidenced in the follow-up of this case.

Efficacy and Safety of Ultrasound-Guided Percutaneous Polidocanol Sclerotherapy Vs Percutaneous Ethanol Injection in Benign Cystic Thyroid Nodules: Preliminary Results

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Radiofrequency versus Ethanol Ablation for Single-Session Treatment of Benign Cystic Thyroid Nodules: A Short-Term Retrospective Study.

This study aims to compare 1-month's efficacy and safety of single-session ethanol ablation and radiofrequency ablation for treating both purely cystic nodules and predominantly cystic thyroid nodules. This short-term retrospective study was approved by the Ethics Committee of the Institutional Review Board of Danang Family hospital, and written informed consent for procedures was obtained for all patients. Thirty-nine patients who presented with cystic thyroid nodules and met inclusion criteria were extracted from the computerized medical records. The internal fluid of cystic thyroid nodules was aspirated as much as possible. Ethanol ablation was performed using 18-gauge needles with 99.5% ethanol, and RFA used a cooled-electrode RFA system and 18-gauge internally cooled electrodes via the trans-isthmic approach, moving-shot technique. Nodule volume, therapeutic success rate, the largest diameter, thyroid function tests, and complications were evaluated and compared before and after treatment in each group. Among 39 patients, 17 patients were undergone EA (mean age of 47.35 years; the proportion of female of 76.5%; purely thyroid cyst percentage of 41.4%) and 22 patients were undergone RFA (mean age of 46.63 years; the proportion of female of 86.4%; purely thyroid cyst percentage of 54.5%). Both treatment techniques showed a significant reduction of the largest diameter and nodule volume (p<0.05) without complications. RFA reduced nodule volume and the largest nodule size greater than EA treatment at 1-month post-ablation (p<0.05). In addition, the therapeutic success rate in the RFA group was higher than in the EA group. Both RFA and EA treatment with single-session confirm the efficacy and safety for cystic thyroid nodules at 1-month follow-up, RFA reduced greater in nodule volume and the largest nodule size than the EA treatment. Thus, the therapeutic success rate in the RFA group was higher than in the EA group.

PSAT323 Ultrasound-guided Percutaneous Ethanol Ablation for the treatment of Benign Cystic Thyroid Nodules: Report of Three Cases on The Initial Ecuadorian Experience

Abstract Introduction Ultrasound-guided Percutaneous Ethanol Ablation (UPEA) is one of the first-line treatments for benign pure cysts and predominantly cystic thyroid nodules (TN). This non-surgical procedure has been used for years worldwide, however, in Latin America, this was recently adopted. Therefore, the aim of this report is to characterize our initial experience with UPEA in Ecuador. Clinical cases description: We report on the cases of a woman (F1: 49 y) and two men (M1: 38 y, M2: 69 y) that underwent UPEA for three predominantly cystic TN at ITECC (Instituto de la Tiroides y Enfermedades de Cabeza y Cuello) in Ecuador. All nodules were non-functioning and graded as Bethesda II. Our approach in regards to the total ethanol volume injected was approximately calculated at 1/3 of the TN volume, using 75% ethanol. 10 ml of 2% lidocaine was used for anesthetic purposes. Initial volume and change in TN volume were calculated with the ATA calculator. Patient F1 had a 40 mm (23.5 ml) right lobe TN and underwent needle extraction of 5 ml of cystic fluid before the injection of 6 ml of ethanol. At 1-month follow-up, the nodule reduced 78.1% in volume (28 mm, 5.1 ml). Similarly, patient M1 had a 59 mm (44.8 ml) right lobe TN treated with 6 ml of ethanol after 20 ml of cystic fluid was extracted from the TN. At 3-month follow-up, the nodule reduced 99% in volume (7 mm, 0.1 ml). Finally, patient M2 had a 36 mm (14.5 ml) right lobe TN treated with 5 ml of ethanol. At 6-moth follow-up, the nodule reduced 99% in volume (0.5 mm, 0.04 ml). No patients developed complications and only needed one session. Conclusions To the best of our knowledge, we are the pioneers in Ecuador and the fourth country in Latin America that implemented UPEA in the management of cystic TN. In this small report, UPEA seems to be an effective and safe treatment option for cystic TN. Patients had &amp;gt;75% reduction in cyst volume along with symptomatic relief and no complications. Our results are consistent with other series. Data on a longer follow-up are needed to confirm long-term efficacy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Safety and efficacy of ethanol ablation for benign thyroid cystic nodules: A single centre experience

Objective To evaluate and audit the safety and efficacy of ultrasound guided ethanol ablation for the treatment of benign thyroid cystic nodules with pressure and cosmetic symptoms. Methods Retrospective case series from November 2018 to March 2021, presented with symptomatic benign cystic thyroid nodules and treated with ethanol ablation. The major clinical outcomes were 6-month volume reduction rate and improvement in pressure symptom scores and cosmetic symptom score. All complications were evaluated. Results We studied thirty-seven consecutive cases with symptomatic benign thyroid cystic nodules. All cystic nodules were confirmed by FNAC to be benign. Seven out of thirty-seven cases received two sessions of ethanol ablation. The initial mean volume of cystic nodules was 17.93ml (range 1.11ml- 60.01ml). The mean volume of ethanol injected was 3.54ml (range 0.5ml-10.0ml). The mean volume at 6-month post ablation was 4.48ml (range 0ml- 60.15ml). The mean volume reduction rate at 6-month post ablation was 80.46%. The median procedure time was 15 minutes. Adverse events were noted in three cases including transient pain and haematoma. The mean pressure symptom score improved from 4.48 (pre-ablation)(range 0-10) to 1.20 (post-ablation)(range 0-5). The mean cosmetic symptomscores improved from 3.45 (pre-ablation) (range 1-4) to 1.37 (post-ablation)(range 1-3). There was one case with salvage hemithyroidectomy arranged. Conclusion Ultrasound guided ethanol ablation is a safe and feasible treatment for symptomatic benign thyroid cystic nodules in terms of volume reduction and symptomatic relief, it serves as an alternative to surgical resection.

Recurrent Laryngeal Nerve Injury in Thermal Ablation of Thyroid Nodules-Risk Factors and Cause Analysis.

Recurrent laryngeal nerve (RLN) injury is a complication of thermal thyroid nodule treatment. We investigated the influencing factors of RLN injury in patients who underwent thermal ablation of thyroid nodules. The data of 1004 patients (252 male, 752 female; median age 44 years) who underwent thermal thyroid nodule ablation were retrospectively reviewed. Patients were divided into benign cystic, benign solid, and papillary thyroid cancer (PTC) groups. The parameters related to RLN injury were analyzed, including the largest diameter, location of the nodules, and shortest distance of the nodule to thyroid capsule and tracheoesophageal groove (TEG). Univariate and multivariate analyses were performed to select risk factors for RLN injury. The RLN injury rate was higher in PTC (6.3%) than in benign cystic (1.2%, P = 0.019) and solid nodules (2.9%, P = 0.018). PTC subgroup analysis showed that the RLN injury rate was higher in T1b (10.7%) and T2 (28.6%) PTC than in T1a PTC (5.0%, P < 0.05). In the PTC group, TEG distance, anterior capsule distance, median capsule distance, posterior capsule distance, and maximum nodule diameter were risk factors for RLN injury. The logistic regression fitting of the nomogram showed high prediction efficiency (C-Index 0.876). The main cause of RLN injury was insufficient medial isolating fluid (MIF). The safety thicknesses of MIF for benign cystic, benign solid, and PTC nodules were 3.1 mm, 3.7 mm, and 3.9 mm, respectively. Several risk factors for RLN injury should be considered before thermal ablation of thyroid nodules. The RLN injury rate could be predicted with the nomogram.

Ethanol ablation for the treatment of benign thyroid nodules

BackgroundEthanol ablation (EA) is a non-surgical option for the treatment of benign cystic thyroid nodules. This study summarizes our preliminary experience with the efficacy and safety of EA. MethodsA retrospective analysis was performed of patients undergoing EA for symptomatic, benign, cystic and predominantly cystic (≥75%) thyroid nodules. Baseline nodule volume, cosmetic scores, and symptom scores were assessed, as well as volume reduction ratio (VRR), cosmetic and symptom scores at post-procedure months 1, 3, 6, and 12. Results31 patients underwent an uncomplicated EA for a single cyst with an average volume of 21.3 cc (range: 1.7–101.4 cc). Follow-up was limited by the COVID-19 pandemic. Mean nodule VRRs were 66 ± 20% (1 m, n = 17), 87 ± 15% (3 m, n = 9), 72 ± 20% (6 m, n = 7), and 78% (12 m, n = 3). Mean symptom and cosmetic scores decreased concurrently post-procedure. ConclusionEA is a safe, effective option for benign cystic and predominantly cystic thyroid nodules.

Percutaneous ethanol injection therapy as the first line of treatment of symptomatic thyroid cysts

BackgroundOur aim was to evaluate the efficacy and security of ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) for the treatment of recurrent symptomatic thyroid cysts in two high-resolution consultations of thyroid nodule in the Valencian Community. Patients and methodsThe study comprised thirty-three consecutive patients (51 ± 12 years, 76% women) with symptomatic benign thyroid cysts relapsed after drainage and benign cytology prior to treatment. Through ultrasound, maximum cyst diameter and volume were determined, and the content of the cyst was drained. We then instilled between 2 and 4 ml of ethanol (according to initial volume). We followed up with ultrasound at one, 3, 6 and 12 months and we calculated the total volume and the Volume Reduction Rate (VRR). We evaluated the perceived pain using a visual analog scale. ResultsThe initial median cyst volume was 11.6 ml (8.5–16.5) A single session of US-PEIT was required in 22 patients (67%), two in 8 (24%) and three in 3 (9%). During PEIT, 49% of the patients experienced virtually no pain, 39% mild pain and 12% moderate pain. There were no complications. After 6 months of follow up the median VRR was 93% (84–98). All the patients achieved a volume reduction of more than 50%, 94% of more than 70% and 56% of more than 90%. Twenty-four patients completed a year of follow-up, achieving a VRR of 97% (93–98). ConclusionsIn our experience US-PEIT has proven to be an effective, safe treatment of symptomatic thyroid cysts. For this reason it can be considered as the first line of treatment and included in the portfolio of services of a high-resolution consultation.

Analyzing the adoption of radiofrequency ablation of thyroid nodules using the diffusion of innovations theory: understanding where we are in the United States?

Thyroid nodules are very common and found in up to 68% of the general U.S. population on ultrasound. Although thyroidectomy has long been the mainstay of treatment for malignant and symptomatic benign thyroid nodules, various interventional ablative techniques have emerged in the last couple of decades as alternative non-surgical treatment options. Globally, the most widely adopted technique has been ultrasound-guided radiofrequency ablation (RFA). RFA of thyroid nodules was first performed in 2002, and there has been an expanding body of evidence since 2006 showing that RFA and other interventional ablative techniques are effective treatments for benign solid thyroid nodules, toxic adenomas, and thyroid cysts. More recently, evidence has emerged that these techniques may be effective treatment for low-risk thyroid cancer and recurrent disease. Despite these findings, the United States has been slow to adopt these techniques, with only a single publication on RFA more than a decade after the first series was published. EM Rogers’ Diffusion of Innovation Theory provides us the appropriate lens to carefully analyze the process of adoption of RFA for thyroid nodules-to understand where we are currently, as well as, the important next steps that must be accomplished in order for RFA and other ablative techniques to be successfully adopted into the management algorithm of thyroid nodules in the United States.

Long-term efficacy and safety of percutaneous ethanol injection (PEI) in cystic thyroid nodules: A systematic review and meta-analysis.

Percutaneous ethanol injection (PEI) is used for the treatment of benign cystic thyroid nodules. This systematic review and meta-analysis aimed to obtain strong evidence of its long-term efficacy and safety. PubMed, CENTRAL, Scopus and Web of Science databases were searched until November 2020 for studies reporting data on volume reduction rate (VRR), compressive symptoms and cosmetic concerns. Associated complications were assessed. A random-effects model was designed to pool the data. Out of 385 papers, nine studies evaluating 1667 nodules were finally included. Overall, VRR at 6, 12, 24, 36, 60 and 120months was 77%, 81%, 72%, 68%, 74% and 69%, respectively. Significant reductions in the compressive symptoms and cosmetic concerns were observed. No permanent complications were observed. The present meta-analysis showed that PEI could significantly reduce the volume of benign cystic thyroid nodules. This reduction was already effective at 6months post-treatment, and the effect was stable over time.

Ultrasound Guided Percutaneous Ethanol Ablation of Benign Thyroid Nodule: A Study From a Tertiary Hospital in Eastern India

Abstract Introduction: Ultrasound guided percutaneous ethanol injection (PEI) of benign thyroid nodule is an easy and effective procedure particularly in cystic and predominantly cystic nodule. Aims: To evaluate efficacy and safety of PEI in managing purely cystic and mixed cystic and solid thyroid nodules. Materials and Methods: Patients of either sex presented with solitary purely cystic benign thyroid nodule, solitary benign mixed with predominantly cystic (&amp;gt;50% of total volume) thyroid nodule, solitary benign mixed with predominantly solid (&amp;gt;50% of total volume) thyroid nodule, solitary solid thyroid nodule were included in this study. Patients who had a nodule BETHESDA 3 and above, pregnancy, patients with critical or terminal illness, patients with other malignancies, multinodular lesions of thyroid, patients with raised T3, T4 and/ or suppressed TSH level were excluded from the study. One hundred sixty patients presenting with thyroid nodule were initially evaluated with thyroid function test and USG. Only those patients with euthyroid solitary thyroid nodules are subjected for fine needle aspiration (FNA). Nodules under BETHESDA 2 are considered for US guided percutaneous ethanol injection (PEI). One hundred twenty-three patients were excluded because of various reasons. Finally ethanol ablation was done in 37 patients. Benign, purely cystic and mixed thyroid nodules were aspirated under ultrasonography guidance. Sterile absolute alcohol (99.99%) (50% of volume aspirated/ maximum 10 ml) was injected and reviewed after 2, 5and 7 months. In case of solid nodule alcohol (50% of nodule volume) was injected. A reduction in volume is calculated at each follow up visit. An adequate response is considered as ≥50 percent reduction in size from baseline after 7 months. If the reduction is &amp;lt;50%, then a second session of absolute ethanol injection is given. Again, patients were similarly followed up after 2, 5 and 7 months. Results: Thirty seven patients underwent PEI. Thirty three patients were considered for final analysis (4 lost to follow up). Response rate of PEI for purely cystic nodule was 100.0% and the overall response rate for mixed nodule was 53.57%. None of the solid nodule responded to PEI even after second session. Among the responder in the mixed nodules, 93.33% responded after first session of PEI. Minor complications like headache occurred in 54.1% patients in the first session. Transient pain at injection site were complained by 86.5% and 37.8% patients in the first and second session respectively. Nausea and vomiting were complained by 18.9% and 16.2% patients in the first and second session respectively. Conclusions: PEI is an effective and safe for purely cystic and mixed thyroid nodules. It is a relatively safe and less invasive procedure from management of benign solitary cystic and mixed thyroid nodules.

Inclusión de la inyección percutánea de etanol como primera línea de tratamiento de los quistes tiroideos sintomáticos

BackgroundOur aim was to evaluate the efficacy and security of ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) for the treatment of recurrent symptomatic thyroid cysts in two high-resolution consultations of thyroid nodule in the Valencian Community. Patients and methodsThe study comprised thirty-three consecutive patients (51±12 years, 76% women) with symptomatic benign thyroid cysts relapsed after drainage and benign cytology prior to treatment. Through ultrasound, maximum cyst diameter and volume were determined, and the content of the cyst was drained. We then instilled between 2 and 4mL of ethanol (according to initial volume). We followed up with ultrasound at one, 3, 6 and 12 months and we calculated the total volume and the Volume Reduction Rate (VRR). We evaluated the perceived pain using a visual analog scale. ResultsThe initial median cyst volume was 11.6mL (8.5-16.5) A single session of US-PEIT was required in 22 patients (67%), two in 8 (24%) and three in 3 (9%). During PEIT, 49% of the patients experienced virtually no pain, 39% mild pain and 12% moderate pain. There were no complications. After 6 months of follow up the median VRR was 93% (84-98). All the patients achieved a volume reduction of more than 50%, 94% of more than 70% and 56% of more than 90%. Twenty-four patients completed a year of follow-up, achieving a VRR of 97% (93-98). ConclusionsIn our experience US-PEIT has proven to be an effective, safe treatment of symptomatic thyroid cysts. For this reason it can be considered as the first line of treatment and included in the portfolio of services of a high-resolution consultation.

Efficacy of Ethanol Ablation for Benign Thyroid Cysts and Predominantly Cystic Nodules: A Systematic Review and Meta-Analysis.

BackgroundUltrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules.MethodsWe conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome.ResultsThe meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia.ConclusionThe role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.