Skip to main content
SpringerLink
Log in

Percutaneous intranodular ethanol injection: A new treatment for autonomous thyroid adenoma

  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Established methods for definitive ablation of autonomous thyroid nodules are surgery and radioiodine. Since it has been demonstrated that percutaneous ethanol injection can inactivate parathyroid adenomas and small hepatocellular carcinomas, we started a trial of this treatment in patients with autonomous thyroid nodules. Twenty-eight patients, 22 toxic and 6 nontoxic, all with undetectable thyrotropin serum levels and suppressed extranodular tissue on scintigraphy, were treated. Treatment consisted of percutaneous intranodular ethanol injection under ultrasound guidance. The total amount of alcohol injected ranged from 0.4 to 2.2 times the estimated nodule volume, divided into 4 to 9 injections performed at 2 to 7 day intervals. Most patients were treated with a single cycle of injections, but 7 of them required 2 cycles. The signs and symptoms of hyperthyroidism disappeared in all cases. Apparently complete cure (normal serum free thyroid hormones, thyrotropin in basal conditions and after thyrotropin releasing hormone, reactivation of extranodular tissue on scintigraphy with nodule no longer visible) was obtained in 17 patients (13 after 1 cycle and 4 after 2 cycles). Partial cure (normal serum free thyroid hormone levels, detectable thyrotropin levels with normal or blunted response to thyrotropin releasing hormone and partial reactivation of extranodular tissue on scintigraphy with nodule or parts of it still visible) was obtained in 10 patients (8 after 1 cycle and 2 after 2 cycles). In 1 patient with a very large nodule thyrotropin levels remained undetectable, but thyroid hormone levels eventually became normal. No recurrences were observed after a follow-up of 12 to 32 months (mean 20 months). No serious side effects were encountered. A clinically valuable result was obtained in all patients. These data suggest that this form of treatment could constitute an alternative to surgery and radioiodine for the ablation of autonomous thyroid nodules.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hamburger J.I. The autonomously functioning thyroid nodule: Goetsch’s disease. Endocr. Rev. 8:439, 1987.

    Article  PubMed  CAS  Google Scholar 

  2. Weiner J.D. Plummer’s disease: localized thyroid autonomy. J. Endocrinol. Invest. 10:207, 1987.

    Article  Google Scholar 

  3. Livraghi T., Paracchi A., Ferrari C., Bergonzi M., Garavaglia G., Raineri P., Vettori C. Treatment of autonomous thyroid nodules with percutaneous ethanol injection: Preliminary results. Radiology 175: 827, 1990.

    PubMed  CAS  Google Scholar 

  4. Monzani F., Goletti O., De Negri F., Del Guerra P., Lippolis P.V., Caraccio N., Chiarugi M., Ferdeghini M., Baschieri L. Autonomous thyroid nodule and percutaneous ethanol injection. Lancet 337: 743, 1991.

    Article  PubMed  CAS  Google Scholar 

  5. Rieger R., Pimpl W., Money S., Rettembacher L, Galvan G. Hyperthyroidism and concurrent thyroid malignancies. Surgery 106:6, 1989.

    PubMed  CAS  Google Scholar 

  6. Romelli P.B., Pennisi F., Vancheri L. Measurement of free thyroid hormones in serum by adsorption chromatography and radioimmunoassay J. Endocrinol. Invest. 2:25, 1979.

    Article  PubMed  CAS  Google Scholar 

  7. Horst W., Rosier H., Schneider C., Labhart A. 306 cases of toxic adenoma: Clinical aspects, findings in radioiodine diagnostics, radiochromatography and histology; results of 131–I and surgical treatment. J. Nucl. Med. 8:515, 1967.

    PubMed  CAS  Google Scholar 

  8. Livraghi T., Festi D., Monti F., Salmi A., Vettori C. US-guided percutaneous alcohol injection of small hepatic and abdominal tumors. Radiology 161:309, 1986.

    PubMed  CAS  Google Scholar 

  9. Livraghi T., Salmi A., Bolondi L, Marin G., Arienti V., Monti F., Vettori C. Small hepatocellular carcinoma: percutaneous alcohol injection. Results in 23 patients. Radiology 768:313, 1988.

    Google Scholar 

  10. Ebara M., Ohto M., Sugiura N., Kita K., Yoshikawa M., Okuda K., Kondo F., Kondo Y. Percutaneous ethanol injection for the treatment of small hepatocellular carcinomas. Study of 95 pa tients. J. Gastroenterol. Hepatol. 5:616, 1990.

    Article  PubMed  CAS  Google Scholar 

  11. Livraghi T., Vettori C. Percutaneous ethanol injection therapy of hepatoma. Cardiovasc. Intervent. Radiol. 13:146, 1990.

    Article  PubMed  CAS  Google Scholar 

  12. Karstrup S., Holm H.H., Torp-Pedersen S., Hegedus L. Ultrasonically guided percutaneous inactivation of parathyroid tumors. Br. J. Radiol. 60:667, 1987.

    Article  PubMed  CAS  Google Scholar 

  13. Karstrup S., Lohela P., Apaja-Sarkkinen M., Borgmastars H., Holopeinen O. Non-operative inactivation of a parathyroid tumor in a patient with hypercalcaemic crisis. Acta Med. Scand. 224:197, 1988.

    Google Scholar 

  14. Charboneau J.W., Hay I.D., Van-Heerden J.A. Persistent primary hyperparathyroidism: successful ultrasound-guided percutaneous ethanol ablation of an occult adenoma. Mayo Clin. Proc. 63: 913, 1988.

    Article  PubMed  CAS  Google Scholar 

  15. Verges B., Cercueil J.P., Pfitzenmeyer P., Pascaud F., Vailant G., Brun J.M., Putelat R. Percutaneous ethanol injection of parathyroid ade nomas in primary hyperparathyroidism. Lancet 337:1421, 1991.

    Article  PubMed  CAS  Google Scholar 

  16. Solbiati L, Giangrande A., De Pra L, Bellotti E., Cantù P., Ravetto C. Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism. Radiology 755:607, 1985.

    Google Scholar 

  17. Vagenakis A.G., Braverman L.E., Azizi F., Portnay G.I., Ingbar S.H. Recovery of pituitary thyrotropic function after withdrawal of prolonged thyroid-suppression therapy. N. Engl. J. Med. 298:681, 1975.

    Article  Google Scholar 

  18. Mariotti S., Martino E., Francesconi M., Ceccarelli C., Grasso L., Lippi F., Baschieri L., Pinchera A. Serum thyroid autoantibodies as a risk factor for de velopment of hypothyroidism after radioactive iodine therapy for single thyroid “hot” nodule. Acta Endocrinol. (Copenh.) 113:500, 1986.

    CAS  Google Scholar 

  19. Ng Tang Fui S.C., Maisey M.N. Standard dose 131-1 therapy for hyperthyroidism caused by autonomously functioning thyroid nodules. Clin. Endocrinol. (Oxf.) 70:69, 1979.

    Article  Google Scholar 

  20. Eyre-Brook I.A., Talbot C.H. The treatment of autonomous functioning thyroid nodules. Br. J.Surg. 69:577, 1982.

    Article  PubMed  CAS  Google Scholar 

  21. Goldstein R., Hart I.R. Follow-up of solitary autonomous thyroid nodules treated with 131-1. N. Engl. J. Med. 309:1473, 1983.

    Article  PubMed  CAS  Google Scholar 

  22. Ross D.S., Ridgway E.C., Daniels G.H. Successful treatment of solitary toxic thyroid nodules with relatively low-dose iodine-131, with low preva lence of hypothyroidism. Ann. Intern. Med. 707:488, 1984.

    Article  Google Scholar 

  23. Hegedus L., Veiergang D., Karstrup S., Molholm Hansen J. Compensated 131–I therapy of solitary autonomous thyroid nodules; effect on thyroid size and early hypothyroidism. Acta Endocrinol. (Copenh.) 778:226, 1986.

    Google Scholar 

  24. Heinze H.G., Bohn U. 131 Jod-Therapie des autonomen Adenoms der Schilddruse. Dtsch. Med. Wochenschr. 772:1073, 1987.

    Article  Google Scholar 

  25. Kinser J.A., Roesler H., Furrer T., Grutter D., Zimmermann H. Nonimmunogenic hyperthyroidism: Cumulative hypothyroidism incidence after radioiodine and surgical treatment. J. Nucl. Med. 30:1960, 1989.

    PubMed  CAS  Google Scholar 

  26. Huysmans D.A, Corstens F.H., Kloppenborg P.W. Long-term follow-up in toxic solitary autonomous thy roid nodules treated with radioactive iodine. J. Nucl. Med. 32:21, 1991.

    Google Scholar 

  27. Berglund J., Christensen S.B., Dymling J.F., Hallengren B. The incidence of recurrences and hypothyroidism following treatment with antithyroid drugs, surgery or radioiodine in all patients with thyrotoxicosis in Malmo during the period 1970–1974. J. Intern. Med. 229:435, 1991.

    Article  PubMed  CAS  Google Scholar 

  28. Molnar G.D., Wilber R.D., Lee R.E., Woolner L.B., Keating F: R. On the hyperfunctioning solitary thyroid nodule. Mayo Clin. Proc. 40:665, 1965.

    PubMed  CAS  Google Scholar 

  29. Blum M., Shenkman L., Hollander C.S. The autonomous nodule of the thyroid: correlation of patient age, nodule size and functional status. Am. J. Med. Sci. 269: 43, 1975.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Servizi di Endocrinologia Servizio di Medicina Nucleare, Ospedale Maggiore, Milano, Italy

    A. Paracchi,  C. Ferrari & P. Raineri

  2. Anatomia Patologica Servizio di Medicina Nucleare, Ospedale Maggiore, Milano, Italy

    R. M. Macchi

  3. Medicina Nucleare, Ospedale Fatebenefratelli, Milano, Italy

    M. Bergonzi

  4. Servizio di Radiologia, Ospedale Civile, Vimercate, Italy

    T. Livraghi

  5. Servizio di Medicina Nucleare, Ospedale Maggiore, Milano, Italy

    E. Reschini

Authors
  1. A. Paracchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. Ferrari
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. T. Livraghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Reschini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. M. Macchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Bergonzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Raineri
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paracchi, A., Ferrari, C., Livraghi, T. et al. Percutaneous intranodular ethanol injection: A new treatment for autonomous thyroid adenoma. J Endocrinol Invest 15, 353–362 (1992). https://doi.org/10.1007/BF03348753

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03348753

Key-words

Search

Navigation