Benign Cystic Thyroid Research Articles

Sonographically Guided Ethanol Sclerotherapy for Benign Thyroid Cysts

We evaluate the efficacy and safety of sonographically guided ethanol sclerotherapy for benign thyroid cysts. We examined 22 patients with benign thyroid cysts (13 complex cysts and nine pure cysts) confirmed by fine-needle aspiration biopsy. Sonographically guided aspiration of the cystic fluid was followed by instillation of absolute ethanol (99.9%) into the cystic cavity: the injected volume of ethanol was 40-100% of the volume of fluid aspirated. The procedure was performed every 1 or 3 months for one or two sessions (mean, 1.2 sessions). Follow-up sonography was performed 1-10 months after the final session, and we observed patients after ethanol sclerotherapy for complications. The initial volume of the cysts ranged from 3.5 to 42 ml. In 21 patients, the volume of the cyst decreased or the cyst was obliterated. The volume of the cyst was reduced by 50-99% in 13 patients and by 1-49% in six patients, and the cyst was obliterated in two patients. In one patient, the volume of the cyst increased. The volume of ethanol instilled was significantly correlated with the volume reduction rate of the cyst. There was a difference in the volume reduction rate between patients in whom 10 ml or more of initial volume was used and those in whom less than 10 ml of initial volume was used; that is, the volume reduction rate of the group with the initial cyst volume of more than 10 ml was higher than that of the other group. Important long-standing and severe complications were not observed. Sonographically guided ethanol sclerotherapy is a safe and effective tool for the therapy of benign thyroid cysts.

Percutaneous ethanol injection therapy in the treatment of thyroid and parathyroid diseases.

Relevant English language articles published from 1966 to 1995 regarding ethanol therapy in the treatment of thyroid and parathyroid diseases were identified through a MEDLINE search and manual searches of identified articles. The sclerosing properties of ethanol have been recognized for many years and have offered interventional possibilities in the management of various benign as well as malignant lesions. The mechanism of action of ethanol appears to be related to a direct coagulative necrosis and local partial or complete small vessel thrombosis. Ultrasound-guided percutaneous ethanol injection therapy (PEIT) is rapid and performed on an out-patient basis and has now gained wide acceptance due to the accumulating evidence of the efficacy and safety of this therapeutic tool. Yet, there is a lack of prospective, randomized clinical trials comparing PEIT with 131I therapy or surgery with regard to its effects, especially long-term ones and it should therefore still be considered an experimental procedure. In benign endocrine diseases, PEIT has shown promising results in the treatment of autonomous thyroid nodules, benign solitary cold solid as well as cystic thyroid nodules and parathyroid tumours. Its use in pretoxic and toxic thyroid nodules has been evaluated in several uncontrolled studies, all demonstrating a high success rate in spite of the large number of treatments needed. So far efficacy and cost-effectiveness seem inferior to 131I and surgery. Short-term results of PEIT in benign cystic thyroid nodules are convincing with a high cure rate, but no controlled studies with long-term results are available. Preliminary results suggest that PEIT could become an alternative to surgical excision or levothyroxine therapy 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-attractive and medical treatment ineffective. However, no prospective randomized trials have been published comparing the results of PEIT in parathyroid tumours with conventional surgical and medical treatments. PEIT has never been tested against standard therapy, but seems inferior to 131I and surgery. Side-effects caused by ethanol injection are generally few and transient and are related to the injection into solid nodules rather than cysts. Ethanol injection into solid profund nodules may seriously jeopardize subsequent surgery because of perinodular fibrosis. As an experimental procedure, not yet evaluated sufficiently, it should be reserved for patients who cannot or will not undergo standard therapy. Caution in routine use is advisable.

Epithelial Cyst of Thyroid.

A benign thyroid cyst lined by thyroid follicular epithelial cells lacking immunoreactivity to thyroglobulin is reported. The patient had a 3 yr history of a large cyst in the lateral anterior neck, with no symptoms of hyperthyroidism or hyperparathyroidism. Water-clear fluid was repeatedly aspirated; analysis indicated the absence of parathyroid hormone (PTH0), T3, and T4. Hemithyroidectomy revealed a simple epithelial cyst. Such cysts are rare, comprising approx 1% of thyroid nodules. A differential diagnosis of cystic neck lesions is presented and the possible pathogenesis of this cyst is discussed.

CA19-9 in Benign Thyroid Cyst

A case of a 64-year-old female with atypical mycrobacterial disease experienced tachycardia and body weight loss. Her serum CA19-9 was elevated(285.0U/ml), and both CT and ultrasonography (US) showed a tumor mass in the pancreatic body. She was operated on for partial pancreatomy. Histological examination of pancreatic sample revealed true cysts. The elevated serum CA19-9 did not change after the operation. She had goiter and laboratory data showed latent thyrotoxicosis. Thyroid US showed multinodular goiter with cystic change and a 123I scintigram revealed autonomously functioning thyroid nodules (AFTN). A fine needle aspiration biopsy of the thyroid did not show any malignant cells. Reduction of serum CA19-9 was demonstrated after every aspiration of the thyroid cyst. We supposed that the high serum level of CA19-9 was due to leakage from the thyroid cyst into the serum.To determine whether a benign thyroid cyst produces CA19-9 and causes elevation of serum concentration, we studied 15 patients with benign cysts of the thyroid. Eleven patients were diagnosed as having adenomatous goiter (AG) with cystic change and four as having Hashimoto disease (HD) with cystic change. A patient with AG showed latent thyrotoxicosis and two patients with HD showed subclinical hypothyroidism. Serum CA19-9 was within normal range in all patients. The CA19-9 content of cystic fluid was higher than the normal serum range (from70.6 to 727000.0U/ml), except in one patient who lacked the Lea and Leb antigen. In every patient of this study, the CA19-9 content of cystic fluid was higher than their individual serum CA19-9.Our results indicate that every thyroid cyst contains CA19-9, and that thyroidal CA19-9 caused an elevation of serum CA19-9 in some cases. CA19-9 is not an indicator for malignant thyroid disease.

Percutaneous Ethanol Injection (PEI): What Is Its Role in the Treatment of Benign Thyroid Nodules?

Ultrasound-guided percutaneous ethanol injection (PEI) was first proposed by Livraghi in 1990 as a possible therapy for autonomously functioning thyroid nodules (AFTN). The procedure is performed on out-patients; is rapid; there is no need of anesthesia, nor of bed rest or patient observation after treatment. Under direct sonographic control a limited amount of 95% sterile ethanol (1-5 ml) is slowly injected into the nodule. In predominantly cystic nodules complete fluid removal is preliminarily performed, and thereafter ethanol is injected on the basis of the aspirated fluid volume without removing the needle. PEI-induced thyroid damage is characterized by coagulative necrosis and haemorrhagic infarction due to vascular thrombosis, and is well defined from the surrounding thyroid parenchyma. Several papers have confirmed the effectiveness of PEI. Normalization of serum TSH and thyroid hormones, marked decrease of nodule volume, and effacement of the previously hyperfunctioning area at thyroid scintiscan are reported in 64-85% of toxic AFTN. Nontoxic AFTN are successfully treated in 80-100% of the cases. PEI significantly superior to aspiration alone in inducing volume reduction of benign cystic thyroid nodules, and the recurrence rate is only 2.5-5%. Complications requiring hospitalization were not reported, but the importance of experienced operators must be stressed to avoid transient dysphonia due to recurrent laryngeal nerve damage. Prior to PEI malignancy must be ruled out by fine needle aspiration in all patients. Radioiodine and surgery remain the treatments of choice of large toxic thyroid nodules, but PEI can be effectively used in selected cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous aspiration and ethanol sclerotherapy for thyroid cysts.

Benign thyroid cysts often recur after aspiration; the effectiveness of tetracycline instillation in the case of recurrence has been questioned. We, therefore, tested the efficacy of percutaneous ethanol injection in 20 patients with "pure" cyst relapsing after aspiration. After evacuation, 95% ethanol was instilled under sonographic guidance and re-aspirated 5 min later. The procedure was performed twice for larger cysts. Follow-up studies were carried out after 1, 3, 6, and 12 months. In case of recurrence at 1 month, patients (n = 5) were submitted to a second session. A slight burning sensation was the only adverse effect. No recurrences were observed at 3 and 6 month follow-up; only one patient with recurrence after 1 month had relapsed at 12 months. A significant shrinkage (P < 0.0001 vs. pretreatment) was observed in all other cases at 12 months; cysts were not detectable in seven patients (35%). No significant variations in thyroid hormone levels were detected during treatment or follow-up. Serum thyroglobulin levels markedly increased 3 h after ethanol injection. One month after treatment, thyroglobulin returned to pretreatment levels, thus excluding progressive thyroid damage. Percutaneous ethanol injection may prove a safe and effective tool for the therapy of thyroid cysts.

The role of thyroid therapy in patients with thyroid cysts

Twenty patients with benign thyroid cysts were studied in a prospective double-blind fashion to determine the effect of thyroid therapy on the recurrence of these cysts after aspiration. When the 10 patients receiving placebo medication were compared with the 10 patients ingesting thyroid hormone, no significant difference was found in the time either group was free of cyst recurrence. We conclude that thyroid therapy is not effective in preventing the recurrence of benign thyroid cysts after initial aspiration.