Possibilities of nontoxic autonomous thyroid nodules treatment by percutaneous ethanol injection

Abstract

Background/Aim. According to the current principles, autonomous functional thyroid nodules are treated by surgery or by radioiodin therapy. Ultrasound guided percutaneous ethanol injection into solid tumors of the soft tissues was a starting point in attempts to treat the thyroid nodules by the same method. The aim of the study was to assess the efficiency of percutaneous injection in treating solitary, nontoxic, autonomous thyroid nodules of up to 15 mL volume. Methods. In 25 patients with solitary nontoxic autonomous thyroid nodules diagnosed by tehnetium-99m scanning as an intensive area having a complete supremacy in the paranodal tissue, an ultrasound guided percutaneous ethanol injection was applied. The procedure was carried out repeatedly once a week until the reduction in nodule size to 50% of the initial size was achieved. Results. An average size of the nodule before curing was 9.68 ? 5.01 mL. An average quantity of the injected ethanol was 9.52 ? 5.08 mL, ie 1.06 ? 0.48 mL/mg of the tissue. The regression of the nodule size in the successfully (?vol% u = - 57.09 ? 13.75%, p < 0.001) and partly successfully cured (?vol du = -48.45 ? 14.35%, p < 0.05) was statistically significant compared to the size before the treatment. After ceasing ethanol injection, 18 months later, a further size regression (?vol% = -79.20 ? 9.89%) compared to the initial one (p < 0.001) was noticed. Soon, after the procedure was finished, a statistically significant concentration increase of Thyroid Stimulating Hormone (TSH) was noticed compared to the initial values (0.18 ? 0.16 vs 0.34 ? 0.31 mU/L, p < 0.01). According to the given criteria, in two female patients satisfactory results were not achieved, but, a year later, in one of them the nodule was not seen by repeated scintigram. The number and frequency of side effects were insignificant. Conclusion. Repeated percutaneous ethanol injections into nontoxic solitary autonomous thyroid nodules result in disappearing of authonomy. The regression of the nodule size of more than 50% compared to its initial volume, as well as the increase in concentration of TSH for more than 50% are the signs of a successful treatment.Uvod/Cilj. Prema sadasnjim principima, autonomni funkcionalni tiroidni nodusi lece se operativno ili terapijskom primenom radioaktivnog joda. Perkutana, ultrazvucno vodjena aplikacija etanola u solidne tumore mekih tkiva bila je polazna osnova za pokusaje lecenja tiroidnih nodusa istom metodom. Cilj ovog rada bio je da se ocene terapijski efekti perkutane aplikacije etanola kod solitarnih, netoksicnih autonomnih tiroidnih nodusa zapremine do 15 mL. Metode. Kod 25 bolesnika sa solitarnim netoksicnim nodusima koji se scintigrafski (tehnecijum 99m) intenzivnije prikazuju i potpuno suprimiraju paranodalno tkivo, uz pomoc ultrazvuka perkutano je aplikovan etanol. Procedura je ponavljana u sedmicnim intervalima dok nije ostvarena redukcija velicine nodusa od 50% u odnosu na pocetnu vrednost. Rezultati. Prosecna velicina nodusa pre lecenja iznosila je 9,68 ? 5,01 mL. Prosecna kolicina aplikovanog etanola iznosila je 9,52 ? 5,08 mL, odnosno 1,06 ? 0,48 mL/mg tkiva. Regresija velicine nodusa kod uspesno (?vol% u = -57,09 ? 13,75%, p < 0,001) i delimicno uspesno lecenih (?vol du = -48,45 ? 14,35%, p < 0,05) bila je statisticki znacajna u odnosu na velicinu pre lecenja. Po prestanku aplikacija etanola, nakon 18 meseci uocena je dalja regresija velicine nodusa (?vol% = - 79,20 ? 9,89%) u odnosu na pocetnu (p < 0,001). Neposredno nakon zavrsene procedure registrovan je statisticki znacajan porast koncentracije tireostimulirajuceg hormona (TSH) u odnosu na pocetne vrednosti (0,18 ? 0,16 vs 0,34 ? 0,31 mU/L, p < 0,01). Prema zadatim kriterijumima kod dve bolesnice nisu ostvareni zadovoljavajuci efekti lecenja, s tim sto se kod jedne, nakon godinu dana, na ponovljenom scintigramu nodus vise nije prikazivao. Broj i ucestalost nezeljenih efekata bio je zanemarljivo mali. Zakljucak. Ponavljane perkutane aplikacije etanola u netoksicne solitarne autonomne noduse stitaste zlezde dovode do iscezavanja autonomije. Regresija velicine nodusa za vise od 50% u odnosu na pocetni volumen, kao i porast koncentracije TSH za vise od 50%, pokazatelji su uspesnog ishoda lecenja.