Treatment of large cold benign thyroid nodules not eligible for surgery with percutaneous ethanol injection

We studied the effect of percutaneous ethanol injection (PEI) in the treatment of cold, cytologically benign, large (> 10 mL) thyroid nodules (CBNs) in 41 patients. The end-point of our study was to evaluate the efficacy of PEI on: 1) local symptomatology, assessed by an arbitrary symptom score; and 2) nodule volume and tracheal displacement (at ultrasonography). Follow-up ranged from 12-36 (21 ± 9) months. Symptom score was significantly reduced (P <0.01) after 6 months and at the end of the follow-up (2.1 ± 0.3 vs. 0.2 ± 0.5 and vs. 0.2 ± 0.4). A significant (P <0.01) nodule volume reduction was observed, without differences between solid or mixed CBNs; the reduction was 50% or more in 92.7% of patients. Neither clinical parameters nor pretreatment nodule ultrasonographic features were related to nodule reduction. Disappearance or significant reduction (>0.5 cm) of tracheal displacement was obtained in 61% and in 39% of patients, respectively. One patient experienced prethyroid region edema, pain, and mild fewer, which reversed within 1 week; and one patient had dysphonia, caused by vocal cord palsy, which reversed spontaneously within 1 month. At the end of the follow- up, nodules with just necrotic material at cytology showed a greater (P <0.05) volume reduction than nodules with residual benign thyroid cells. Our data suggest that PEI is a safe and effective treatment of large CBNs, although sometimes serious side effects do occur.