[Percutaneous ultrasound-guided ethanol sclerotherapy of autonomous thyroid nodules]

Percutaneous ethanol injection therapy for autonomously functioning thyroid nodules has been performed in 53 patients. 36 patients suffered from hyperthyroidism, and 17 patients had subclinical hyperthyroidism. Ethanol was administered under ultrasonographic guidance in 2-6 sessions depending on the size of the nodule Local neck pain was the most often adverse effect. Transient dysphonia occurred in 3 patients. A subacute granulomatous thyroiditis-like reaction within 1 week after the last session occurred in 4 patients. During a 10-day steroid administration this reaction was stopped. After ethanol sclerotherapy reduction of thyroid nodular volume can be achieved. The reduction of the nodules was between 36 and 75% (mean 55 +/- 15%) of the pre-treatment volume at 6 week after therapy. In 27 of 36 hyperthyroid patients the FT4- and T3-levels became normal. Repeated sclerotherapy was successfull in 6 of the remaining 9 hyperthyroid patients. No relapse of hyperthyroidism was observed. The scintiscan showed a complete cure in 10 of 23 patients one year after PEI-therapy, while in 11 patients partial normalization of the scintiscan was observed. In 2 of 23 patients the scintiscan remained unchanged. Indication of ethanol sclerotherapy is not clear. The method appears an effective alternative procedure in patients with large nodules at high surgical risk. Under special circumstances (pregnancy or iodine-induced hyperthyroidism) ethanol sclerotherapy may be a practical alternative for toxic autonomously functioning thyroid nodules.