21 Century: The Golden Age of Non-Surgical Interventional Thyroid Ablation

21 Century: The Golden Age of Non-Surgical Interventional Thyroid Ablation

21 Century: The Golden Age of Non-Surgical Interventional Thyroid Ablation

21 Century: The Golden Age of Non-Surgical Interventional Thyroid Ablation.

How did we get here? Start with Ethanol Ablation for Cysts PEI

  1. 30 years ago ethanol PEI was proposed to treat different kinds of  tumors, adrenal cysts and parathyroid hyperplasia..
    1. First documented use of ethanol  for thyroid cysts was in 1989 by Rozman et al .
    2. Recognized as first line treatment for thyroid cysts in 2003 replacing surgery.
    3. Pure thyroid cysts are only 1%. Mixed cyst solid nodules with >50% cyst fluid are 25-30% of the nodules. Both are candidates form PEI if the solid parts are negative by needle biopsy and molecular testing.
    4. 1976 Jensen et al showed that aspiration of the cyst content rarely prevented recurrence.
    5. Many studies  all show 64-93% reduction in cyst size published over 2 decades.
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    7. PEI has been shown to be safe, inexpensive compared to surgery, and easily repeatable.
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    9. Local symptoms and cosmetic factors are corrected in 75-95% of cases.
    10. Sung et al showed symptoms dropped from 4/4 to 1/4 on a post PEI interview. Similar  improvement in cosmetic look was found by Sung.
    11. Randomized study by Bennedbaek et al  found PEI better than saline injection alone.
    12. Recurrence rates over 5 years 3.4%  and 10 years 6.5%
    13. Complex cysts or very large cysts had higher recurrence rates.
    14. Multilocular complex cysts may need more than one treatment.
    15. Highly viscus cyst fluid ( snow globe-like effect ) may need a 2 step approach with a small amount on ethanol inject at first and return when the fluid has become less dense.
    16. Every successful PEI treatment saves Thousands of dollars in surgery and hospital expense, not to mention the pain and suffering of major surgery
    17. Thyroglossal duct cysts are usually a surgical disease until PEI.
    18. However, Kim et al in 2011 treated 11 TGD cysts with 80% success avoiding surgery. Very viscous cyst fluid is one technical problem but larger bore needle corrected the problem.
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    20. True parathyroid cysts are also treated successfully by PEI. Watery clear fluid and positive needle washout for PTH makes the diagnosis.Some parathyroid cysts have brown or bloody fluid after a bleed and PTH/Tg washout will make the diagnosis.
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    22. Hay et al from Mayo clinic in 2011-2012 reported using PEI in thyroid cancer treatment.Recurrence of thyroid cancer neck lymph nodes can be treated with PEI instead of risky  costly second neck dissection surgery.
    23. Call Matt at my center for details to be evaluated for PEI if you have a big symptomatic cyst or it is ugly to your eyes or recurrent thyroid cancer lymph nodes in the neck. 310-393-8860.
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