Research article

Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection

Bagher Larijani¹ , Mohammad Pajouhi¹ , Hossein Ghanaati² , Mohammad-Hassan Bastanhagh¹ , Fereshteh Abbasvandi¹ , Kazem Firooznia² , Mahmood Shirzad¹ , Mohammad-Reza Amini¹ , Maryam Sarai¹ , Nasreen Abbasvandi¹ and Reza Baradar-Jalili¹

¹Endocrinology & Metabolism Research Centre, Tehran University of Medical Sciences, Tehran, Iran

²Medical Imaging Centre, Imam Khomeini University Hospital, Tehran, Iran

author email corresponding author email

BMC Endocrine Disorders 2002, 2:3doi:10.1186/1472-6823-2-3

Published:	6 December 2002

Abstract

Background

Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules.

Methods

35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (<0.24 μIU/ml) and normal thyroid hormone levels. Ethanol injections were performed once every 1–4 weeks. Ethanol injections were stopped when serum T₃, T₄ and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection.

Results

Average pre-treatment nodule volume [18.2 ± 12.7 ml] decreased to 5.7 ± 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 ± 0.02 μIU/ml to 0.65 ± 0.8 μIU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T₄ and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia.

Conclusion

Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules.