Thyroid No Surgery 101: Thyroid Nodules Treated Without Surgery with Ethanol Ablation PEI

Thyroid No Surgery 101: Thyroid Nodules Treated Without Surgery with Ethanol Ablation PEI

Thyroid No Surgery 101: Thyroid Nodules Treated Without Surgery with Ethanol Ablation PEI

Thyroid No Surgery 101: Thyroid Nodules Treated Without Surgery with Ethanol Ablation PEI

Series of images by Dr.Enrico Papini showing the volume decrease from 18 ml to 0.4 ml by one year.

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  1. Referral to an interventional thyroidologist doing PEI. The endocrinologist/internist / primary care/ and even the patient  can make the request.
  2. All the prior thyroid records, imaging, and biopsies including actual slides need to be sent before the candidate evaluation appointment.
  3. 6 month history of the cyst including a drainage and biopsy. She feels pressure and does not like the looks of the mass on the left side of her neck.
  4. Physical examination visible firm left sided mass with trachea deviated to the right.
  5. Thyroid functions tests were all normal including thyroid antibodies.
  6. Ultrasound 63 ml, 6 cm cyst.
  7. USGFNA and molecular markers and gene classifiers were benign.The needle washout confirmed the thyroid origin of the cyst TG 291,920 n<1. PTH <25. After the biopsy because in the first drainage procedure her endocrinologist could remove only a portion of the fluid 9 cc ,it was determined the fluid was very thick. 45cc was withdrawn with an #18 needle.
  8. Review of first biopsy was inadequate for diagnosis.
  9. She returned in 2 weeks to have the PEI.
  10. After prep she had the PEI under direct ultrasound real time imaging. The cyst fluid was removed and ethanol injected, and washed in and out and then withdrawn with 5 cc left in.
  11. She had no complications and only slight pressure with the insertion of the #18 needle, mild tingling on withdrawal of the needle. She left the office in 60 minutes.
  12. The patient returned in 4 weeks post PEI to confirm the treatment had treated had worked.
  13. PEI has been determined to be the first line treatment for thyroid,parathyroid cysts by American College of Endocrinology.
  14. Call Matthew 1-310-393-8860, thyroid.manager@protonmail.com to see if you are a candidate for PEI.
  15. Richard Guttler MD,FACE,ECNU, Interventional thyroidologist.
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