Patient with a Large Neck Cyst with Choking and Pressure Symptoms. Told to Have Surgery.
The patient refused surgery and sought alternative treatment.
35Y/O M with 6 months of progressive neck symptoms. Examination of the neck only found a soft mass in the right lobe and midline. All thyroid tests were normal. Calcium was elevated at 10.6 mg/ml.The location suggested it might be a functioning parathyroid cyst.
Diagnostic Ultrasound very large 7.6×4.3×3.7 cm volume 64 ml pure cyst. Ultrasound guided FNA and cutting needle biopsy was done. Needle washout for PTH was negative ruling out parathyroid disease but Thyroglobulin was 16,791 ( N= >1.0 ) consistent with a large thyroid cyst.The thyroid 30 ml cyst fluid removed was brown in color.
During the biopsy a 30 ml sample of the cyst fluid was taken to see if it was thick or thin fluid. The brown fluid was liquid or viscous.
The cutting needle of capsule was consistent with a benign thyroid cystic nodule.
Cutting needle with normal thyroid follicles with colloid.
His symptom score was 8/10.
The final diagnosis was a large benign thyroid cyst.
Patient explained the treatment of choice was not surgery but ethanol ablation PEI.
The plan included local Lidocaine injection of the skin and thyroid capsule and then under US guidance #18 gauge needle would be inserted into the center of the cyst. Cystic fluid removed and if thick saline washout would be used. After 60 ml cyst fluid was removed 30 ml of 200 proof ethanol would be injected. The ethanol would be left in for 15 minutes. After removing the ethanol,the patient would be kept for 30 minutes to make sure there were no complications. Another 30 minutes in the examination room for post PEI discussion. Follow up ultrasound in 6 weeks.
The patient agreed to the plan and is planning to have the treatment when the virus lock out is over.
Keep your thyroid and forget surgery.
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