Thick Viscous Thyroid Nodule Cyst Fluid? Use a Larger Needle

Thick Viscous Thyroid Nodule Cyst Fluid? Use a Larger Needle

Thick Viscous Thyroid Nodule Cyst Fluid? Use a Larger Needle

Thyroid cyst with thick fluid treated with 2 step PEI

One-Step Ethanol Ablation of Viscous Cystic Thyroid Nodules
Jin Yong Sung1, Jung Hwan Baek1, Yoon Suk Kim1, Hyun Jo Jeong1, Min Sook Kwak1, Ducky Lee2 and Won-Jin Moon3
Citation: American Journal of Roentgenology. 2008;191: 1730-1733. 10.2214/AJR.08.1113

OBJECTIVE. The purpose of this study was to evaluate the efficacy and safety of one-step ethanol ablation in the management of viscous cystic thyroid nodules.

MATERIALS AND METHODS. Viscous cystic thyroid nodules are defined as nodules that cannot be aspirated with an 18-gauge needle. Nine euthyroid patients underwent one-step ethanol ablation of benign single compressive viscous cystic thyroid nodules (cystic portion > 90%). The thick content of the nodules was removed with either a 16-gauge needle (n = 8) or an 8.5-French pigtail catheter (n = 1) connected to a suction pump. An injection of 99% sterile ethanol then was administered. After 10 minutes, all of the injected ethanol was withdrawn. Additional treatment was prescribed if the cystic portion of the nodule remained larger than 1 mL. Follow-up sonography was performed 1 and 6 months after treatment. At each follow-up examination, nodule volume, symptom score (centimeter visual analog scale, 0–10), cosmetic grade (grade 1–4), and complications were evaluated.

RESULTS. The mean volume of index nodules was 24.4 ± 20.3 (SD) mL (range, 4.5–57.4 mL). The mean amount of ethanol injected was 11.8 ± 10.1 mL (range, 2–27 mL). The mean total procedure time was 27.8 ± 10.4 minutes (range, 15–45 minutes). One month after ablation, the mean volume of the nodules had decreased significantly (7.2 ± 9.4 vs 24.4 ± 20.3 mL, p = 0.008). Additional reduction was found at the 6-month follow-up examination, the mean nodule volume being 2.1 ± 3.8 mL (p = 0.008). The mean volume reductions at 1 and 6 months were 78.4% ± 14.4% and 93.6% ± 6.8%. The mean symptom score decreased from 3.2 ± 1.5 to 0.4 ± 1.0 (p < 0.05) and the mean cosmetic grade from 3.9 ± 0.3 to 1.3 ± 0.7 (p < 0.05). No major complications were encountered. CONCLUSION. One-step ethanol ablation is an effective and safe method of management of viscous cystic thyroid nodules. Keywords: ethanol ablation, thyroid intervention, viscous cystic thyroid nodule Comments: Instead of a massive needle I use a 2 step method. I inject a small amout of ethanol in the middle of the viscous fluid cyst. I wait for a week and when the fluid is more liquid I finish the ablation. Richard Guttler MD,FACE,ECNU

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