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Percutaneous Ethanol Injection of Hyperfunctioning Thyroid Nodules: Long-Term Follow-Up in 125 Patients

¹ Interventional US Unit, Department of Medicine, S. Giovanni di Dio Hospital, 80059 Torre del Greco (NA), Italy.
² Present address: via montedoro 43 is. B (parco montedoro), 80059 Torre del Greco (NA), Italy.
³ VS. Maria della Pietà Hospital, ASLNA3, Casoria (NA), Italy.
⁴ Division of Surgery, Department of Surgery, Anesthesiology, and Emergency, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —41-year-old woman with hyperthyroidism and single hyperfunctioning nodule in right lobe of thyroid. Scintigraphy image shows hyperuptake of nodule in right thyroid lobe and complete absence of uptake in thyroid parenchyma.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —41-year-old woman with hyperthyroidism and single hyperfunctioning nodule in right lobe of thyroid. Power Doppler sonogram shows hypervascularity of nodule.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —41-year-old woman with hyperthyroidism and single hyperfunctioning nodule in right lobe of thyroid. After three sessions of percutaneous ethanol injection, power Doppler sonogram shows inhomogeneous pattern of nodule and absence of intralesional vascularity.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —41-year-old woman with hyperthyroidism and single hyperfunctioning nodule in right lobe of thyroid. Image from posttreatment scintigraphy performed after 2 months shows complete absence of uptake in nodule and recovery of uptake of thyroid parenchyma.

View larger version (17K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Flowchart shows percutaneous ethanol injection (PEI) treatment schedule. HFTN = hyperfunctioning thyroid nodule, TSH = thyroid-stimulating hormone, FT3 = free triiodothyronine, FT4 = free thyroxine.

View larger version (187K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —52-year-old man with hyperthyroidism and large hyperfunctioning nodule in right lobe of thyroid. Gray-scale sonogram shows solid, homogeneously echogenic nodule (arrows) in right thyroid lobe.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —52-year-old man with hyperthyroidism and large hyperfunctioning nodule in right lobe of thyroid. Scintigraphy image shows hypweruptake of nodule and complete absence of uptake in thyroid parenchyma.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —52-year-old man with hyperthyroidism and large hyperfunctioning nodule in right lobe of thyroid. After three percutaneous ethanol injection sessions, large part of nodule is hypoechoic and inhomogeneous (arrowheads), whereas two residual areas of nodule, small one at upper pole (open arrow) and larger one at caudal portion of nodule (solid arrow), are still solid and homogeneously echogenic.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —52-year-old man with hyperthyroidism and large hyperfunctioning nodule in right lobe of thyroid. Power Doppler sonogram shows vascular signals only in upper polar residual area (open arrow), whereas signal in caudal area seems avascular (solid arrow).

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3E —52-year-old man with hyperthyroidism and large hyperfunctioning nodule in right lobe of thyroid. Posttreatment scintigraphy image, in agreement with B-mode sonogram, shows increased uptake in both upper pole region (open arrow) and caudal portion (solid arrow) of nodule.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Flowchart shows results of percutaneous ethanol injection (PEI) in this study. HFTN = hyperfunctioning thyroid nodule, TSH = thyroid-stimulating hormone, FT3 = free triiodothyronine, FT4 = free thyroxine.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. Power Doppler sonogram shows hypervascular nodule (arrows) of left lobe of thyroid gland.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. Scintigram shows hyperuptake of nodule (arrows) and complete absence of uptake in thyroid parenchyma.

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. After percutaneous ethanol injection (PEI) treatment with 15 mL of ethanol, nodule (N) appears completely avascular on power Doppler sonogram; power Doppler signals are evident only at periphery of nodule (arrows).

View larger version (201K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. Posttreatment scintigram performed 2 months after PEI shows complete absence of uptake in nodule (N) and recovery of uptake of thyroid parenchyma.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. Power Doppler sonogram obtained 18 months after PEI shows growth of hypervascular tissue (arrows) along superior and medial margins of treated nodule (N).

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5F —61-year-old woman with hyperthyroidism and single hyperfunctioning nodule in left lobe of thyroid. New scintigram shows recurrence of hyperfunctioning tissue (arrows) in cephalic portion of nodule (N) previously treated with PEI.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —34-year-old woman treated with four sessions of percutaneous ethanol injection for hyperfunctioning nodule in right lobe of thyroid. Doppler sonography of completely ablated hyperfunctioning thyroid nodule shows hypervascular aspects in posttreatment examination. Duplex sonography performed 12 months after treatment shows multiple power Doppler sonography signals and turbulent low-resistance flow in nodule. Patient is euthyroid (normal free triiodothyronine [FT3], free thyroxine [FT4], and thyroid-stimulating hormone [TSH]). Power Doppler findings are consistent with arteriovenous shunts in fibrotic nodule rather than with persistence of hyperfunctioning tissue.

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