Percutaneous Ethanol Injection as Treatment for Thyroid Cystic Nodules

Background: Thyroid cystic nodules are common and frequently benign. Aspiration of thyroid cyst decreases compression symptoms and volume. However, they commonly recur, and usually, surgery is required for definitive treatment. A less invasive approach, done less frequent, is percutaneous ethanol injection (PEI), which has shown fewer recurrences than simple aspiration and is well-tolerated with few side effects. We present 2 patients that where treated in our clinic with PEI. Clinical Case: 41-year-old female with a history of primary hypothyroidism on Levothyroxine, with neck discomfort, and no risk factors for thyroid cancer had a cystic thyroid nodule 1.5 x 1.8 x 2.8 cm over the right thyroid lobule. Cytology results reported as Bethesda II. One year later, her thyroid nodule was 1.9 x 2.6 x 3.3 cm. Underwent FNA and 6 cc of dark brown liquid was drained from the cyst which was reported again as Bethesda II. The patient was monitored with thyroid ultrasound after a year, and the cystic nodule was 2.2 x 2.9 x 3.1 cm. PEI was decided as the next approach. After six cc was aspired, 0.5 cc of desiccated ethanol was injected into the remained cystic. Eight months after PEI, cystic size was 0.7 x 0.9 x 0.8 cm. The second case is a 40-year-old female who presented complaining of neck discomfort without changes in her voice. The patient did not have any risk factors for thyroid cancer. Thyroid ultrasound was done, which showed a 2.3 x 2.7 x 3.3 cm cyst on her right thyroid lobe. PEI was arranged and 9 cc of dark fluid was aspirated with a posterior injection of 0.5 cc of desiccated ethanol. Symptoms resolved, and the patient was lost to follow up. Five years later, she was seen again. Neck ultrasound showed a cyst of 0.4 x 0.6 x 0.8 cm on her right thyroid lobe. Neither of the two patients had a side effect associated, and the procedure was well tolerated. Conclusions: Percutaneous ethanol injection is a good alternative in the treatment for cystic thyroid nodules due to decrease in cystic size, which we observed that continued for five years of follow up in one of our patients. These will avoid frequent cystic aspiration secondary to recurrence or invasive surgical management.