How safe is percutaneous ethanol injection PEI for treatment of thyroid nodule? Report of a case of severe toxic necrosis of the larynx and adjacent skin.
Since 1990, percutaneous ethanol injection therapy (PEIT) has been clinically applied as a treatment for autonomous functioning nodules of the thyroid as well as for cystic lesions. Some additional indications are currently under consideration, e.g. inoperable advanced cancer of the thyroid. Since its inception, PEIT has generally been regarded as an effective, low-risk, inexpensive procedure which can be performed on an ambulatory basis.
MATERIAL AND METHODS:
We report the first case of severe ethyl toxic necrosis of the larynx combined with necrotic dermatitis in a patient treated with PEIT by a radiologist.
The patient was admitted to hospital, where the necrosis and dermatitis were treated conservatively. A cyst which developed in the right false vocal fold was removed by microsurgery 10 months later. Voice was restored almost to normal but a significant reduction in nodular volume was not seen, probably due to the inexperience of the operator.
PEIT for functional thyroid gland autonomy is an inexpensive method of treating hyperthyroidism with focal autonomy on an ambulatory basis if surgical intervention and radioiodine therapy are not feasible either for medical reasons or because of refusal by the patient. Severe complications must be taken into consideration and discussed with the patient.
To avoid complications, substantial experience and a precise ultrasound-guided injection are required. In the case of complications the opinion of a specialist should be sought at an early stage.
Comments: No deaths and few serious complications with PEI. A rare case like this should not stop you from seeking an expert and doing PEI as it is safer than surgery if you have a benign cystic parathyroid or thyroid cysts or recurrent thyroid cancer in neck lymph nodes. Also the future use for primary micro-papillary thyroid cancer has been studied at Mayo Clinic as a thirsd arm to surgery or active surveillance without surgery.
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Richard Guttler MD FACE,ECNU