Abstract
Twenty-five patients with solitary autonomous thyroid nodules (15 nontoxic, 10 toxic) received percutaneous ethanol injection treatment (PEIT) under sonographic guidance in 4–7 sessions (1–2 weekly). To test different doses, smaller nodules (volume <15 mL) were given 0.75–2.8 mL ethanol/mL nodular tissue while larger nodules received 0.5–1 mL/mL. Except for 1 patient who developed hyperpyrexia, no relevant adverse effects were observed. A slight, asymptomatic increase in serum thyroid hormone levels was observed in both groups during the treatment. Three months after treatment, a biochemical and clinical remission of hyperthyroidism was observed in 8 of 10 patients with toxic nodules. A significant increase of TSH level was seen in both groups (p<0.01). Significant shrinkage of volume (p<0.001) as well as structural alternations of nodules were consistently recorded at sonography. A linear relationship (r=0.98;p<0.0001) between pretreatment volume and volume reduction was found both for large and small nodules, thus suggesting that even limited ethanol doses may be therapeutically effective. A recovery of extranodular parenchyma activity at scintiscan occurred in 16 (64%) of 25 patients. These data confirm that PEIT is effective in obtaining functional ablation and in inducing remission of hyperthyroidism. Adverse effects are infrequent. In spite of the small patient sample, a 0.5–1 mL ethanol dose per each mL of tissue appears as effective as larger doses and seems appropriate for treatment.
Résumé
On a injecté de l'éthanol par voie percutanée (IEP) et sous échographie chez 25 patients ayant un nodule solitaire autonome de la thyroïde (15 non-toxiques, 10 toxiques), à raison de 4–7 séances (1–2 par semaine). Pour évaluer les doses nécessaires en fonction de la taille, les patients ayant un nodule plus petit (volume <15 mL) ont reçu 0.75–2.8 mL de'éthanol/mL de tissu nodulaire, alors que ceux porteurs de nodules de plus gros volume ont reçu un volume dose de 0.5 mL/mL. Hormis un cas d'hyperpyrexie transitoire, il n'a pas été observé d'effects secondaires notables. On a constaté une augmentation modérée, asymptomatique, des taux hormonaux sériques dans les deux groupes pendant le traitement. Trois mois aprés la fin du traitement, une rémission clinique et biologique a été observée chez 8 des 10 patients ayant un nodule toxique. Une augmentation significative des niveaux de TSH a été notée dans les deux groupes (p<0.01). Une diminution significative du volume (p<0.001), ainsi que des modifications structurales ont toujours été documentées par l'échographie. Une corrélation linéaire hautement significative a été retrouvée (r=0.98;p<0.0001) entre le volume pré-opératoire et la réduction tumorale à la fois pour les grands et les petits nodules, suggèrant que même une injection limitée d'éthanol peut être thérapeutiquement efficace. La récupération d'une activité scintigraphique extranodulaire a été observee chez 16 des 25 patients (64%). Ces données confirment que l'IPE est un moyen efficace pour obtenir une “ablation fonctionnelle” de la thyroïde et induire une rémission d'hyperthyroide. Les effets secondaires apparaissent peu fréquents. Malgré la taille réduite des effectifs dans cette étude, il semble que la dose de 0.5–1 mL d'éthanol par mL de tissu soit aussi efficace qu'une dose plus importante.
Resumen
Veinticinco pacientes con nodulos tiroideos solitarios autónomos (15 no tóxicos, 10 tóxicos) fueron tratados mediante inyección de etanol por vía percutánea (TIEP) bajo guía ultrasonigráfica en 4–7 sesiones (1–2 semanales). Con el objeto de probar diferentes dosis, los nódulos pequeños (volumen<15 mL) fueron tratados con dosis de 0.75–2.8 mL etanol/mL de tejido nodular, en tanto que los nódulos mayores recibieron 0.5–1.0 mL. Aparte de un paciente que exhibió hiperpirexia transitoria, no se observaron efectos adversos. En el curso del tratamiento se registró una leve y asintomática elevación de los niveles séricos de hormona tiroidea en ambos grupos. A los tres meses de efectuado el tratamiento se comprobó remisión bioquímica y clínica del hipertiroidismo en 8 de 10 pacientes tóxicos, y elevación significativa de los niveles de TSH en ambos grupos (p<0.01). En forma consistente la sonografía demostró reducción significativa del volumen (p<0.0001) y alteraciones estructurales de los nódulos. Se encontró una relación linear entre el volumen de la masa anterior al tratamiento y la reducción, tanto para los nódulos grandes como para los pequeños, lo cual sugiere que aún las dosis limitadas de etanol poseen eficacia terapéutica. Se demostró recuperación de la actividad parenquimatosa extranodular en 16 de 25 pacientes (64%). Los datos confirman que el TIEP es efectivo para lograr la ablación funcional y la remisión del hipertiroidismo, cuando éste se encuentra presente; los efectos adversos son muy raros. A pesar de lo pequeno de la muestra de pacientes, parece que una dosis de 0.5–1.0 mL de etanol por cada mL de tejido es tan eficaz como las dosis mayores y que resulta apropiada para el tratamiento de los nódulos solitarios autónomos de la glándula tiroides.
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Goletti, O., Monzani, F., Caraccio, N. et al. Percutaneous ethanol injection treatment of autonomously functioning single thyroid nodules: Optimization of treatment and short term outcome. World J. Surg. 16, 784–789 (1992). https://doi.org/10.1007/BF02067387
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DOI: https://doi.org/10.1007/BF02067387