The Clinical Evaluation of a Patient Being Considered for Ethanol Ablation of a Large Thyroid Cyst. ( Typical case ) SS 37 Y/O F.
referred by her endocrinologist
- Referral to an interventional thyroidologist doing PEI. The endocrinologist/internist / primary care/ and even the patient can make the request.
- All the prior thyroid records, imaging, and biopsies including actual slides need to be sent before the candidate evaluation appointment.
- 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.
- Physical examination visible firm left sided mass with trachea deviated to the right.
- Thyroid functions tests were all normal including thyroid antibodies.
- Ultrasound 63 ml, 6 cm cyst.
- 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her endocrinologist could remove only a portion of the fluid 9 cc ,it was determined the fluid was very thick. 45cc was withdrawn with an #18 needle.
- Review of first biopsy was inadequate for diagnosis.
- She returned in 2 weeks to have the PEI.
- 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 The cyst fluid was removed and ethanol injected, and washed in and out and then withdrawn with 5 cc left in.
- 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.
- The patient returned in 4 weeks post PEI to confirm the treatment had treated had worked.
- PEI has been determined to be the first line treatment for thyroid,parathyroid cysts by American College of Endocrinology.
- Call Matthew 1-310-393-8860 to see if you are a candidate for PEI.
- Richard Guttler MD,FACE,ECNU
- Image of the neck examination showing the air pipe shifted over from pressure of the big cyst