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Percutaneous ethanol injection treatment of autonomous thyroid adenoma: hormonal and clinical evaluation

1992; Wiley; Volume: 36; Issue: 5 Linguagem: Inglês

10.1111/j.1365-2265.1992.tb02251.x

1365-2265

Fablo Monzanl, Orlando Golettl, Nadla Caracclo, Paolo Del Guerra, Marco Ferdeghinl, Enrico Puccl, L Baschieri,

Thyroid and Parathyroid Surgery

OBJECTIVE We have evaluated the efficacy of percutaneous ethanol Injection as an alternative to surgery and iodlne‐131 treatment in solitary autonomous thyroid adenoma. DESIGN Percutaneous ethanol Injection (0.5–2.8 ml ethanol/ml nodular tissue) was performed under sonographic guidance in 3–5 (1–2 weekly) sessions; a 7.5 MHz linear real‐time scanner (Toshiba, mod. 32B) was used for sonographic studies. The thyroid hormone profile was assessed during treatment and for the next 6 months. PATIENTS Fifty‐six patients (40 females, 16 males, mean age 46.SD 9 years; 30 pretoxic, 26 toxic) were included in the study: their pretreatment technetlum‐99 m thyroid scan showed a single hot nodule with total suppression of extranodular tissue in 45 and near‐total suppression in 11. MEASUREMENTS Thyroid hormones, antithyroglobulin and antiperoxidase antibodies were measured by specific radloimmunoassay, while thyrotrophin was evaluated by ultrasensitive Immunoradiometric assay. RESULTS Apart from a case of transient pyrexia, no relevant adverse effects were observed. A slight thyrold hormone increase was seen in both groups immediately following a treatment. Six months after therapy a biochemical and clinical remission of hyperthyroldism was observed in 18 out of 22 toxic patients (81.8%); a significant increase of TSH levels was seen in both groups ( P <0.01). With follow‐up, significant volume shrinkage ( P < 0.001) as well as structural alterations of the nodule were consistently recorded at sonography; a linear relationship ( r = 0.98; P <0.0001) between pretreatment volume and volume reduction was found. At scintiscan, functional activity of extranodular parenchyma was found In 40 out of 56 patients (71.4%), 16/26 (61.5%) In the hyperthyrold group, 24/30 (80.0%) In the pretoxic group. CONCLUSIONS These data confirm that percutaneous ethanol Injection is effective in obtaining functional ablation and in Inducing remission of hyperthyroldism, when present; adverse effects seem infrequent.