Técnicas mínimamente invasivas para el manejo de los nódulos tiroideos benignos: eficacia e impacto sobre la calidad de vida de la inyección percutánea de etanol. Resultados en una unidad de alta resolución de nódulo tiroideo

Background and objective

The high incidence of thyroid nodular disease has raised concerns on the therapeutic management of benign thyroid nodules. The development of minimally invasive techniques is an alternative to surgery and has a low rate of complications. Our objective was to evaluate the safety and efficacy of percutaneous ethanol injections (PEI) with ethanol aspiration of symptomatic cystic and predominantly cystic thyroid nodules (cystic component > 50%) treated in the thyroid nodule high-resolution unit (TNHRU) of Hospital de Tortosa Verge de la Cinta Hospital.

Patients and methods

The present work is a prospective, observational and descriptive study of 32 patients (87.5% women, mean age of 43; SD, 12) evaluated at the TNHRU from August 2022 through December 2023. Demographic data such as age, sex, previous thyroid function, diagnostic method, initial nodular volume, nodular composition and nodular location were analyzed. Using ultrasound, measurements of diameters and thyroid nodule volume were taken. We aspirated the 50% of the cystic content and injected between 2 mL and 5 mL of 99% ethanol (depending on cystic volume). After letting the ethanol act inside the nodule for 5 to 10 minutes, all the cystic content and the injected ethanol were aspirated. We performed an ultrasound follow-up at 1, 3 and 6 months, evaluating the total volume and the volume reduction rate (VRR). The impact on health-related quality of life (HRQoL) was assessed using the ThyPRO-39es questionnaire, which was administered before and after the PEI treatment at the 6-month follow-up.

Results

The median volume reduction at the end of the 6-month follow-up was 0.23 mL (0.00-0.67), and the VRR, 98.57% (94.80-100.00). The difference between the initial volume and the volume at the 1-, 3-, and 6-month follow-up was statistically significant, so was the VRR between the 1-month and the 3- and 6-month follow-up. Six patients (18.80%) required 2 PEIs and only 2 patients (6.3%) required 3 PEIs. The overall quality of life, which was scored from 0 (good) to 4 (poor), significantly improved from 1.28; SD, 0.81 up to 0.19; SD, 0.40 (P<.001).

Conclusions

PEI is an effective alternative to treat cystic thyroid nodules resulting in an improved patients’ HRQoL. It can be performed in an outpatient setting with a low rate of complications, thus making it suitable for inclusion in the service portfolio of a HRTNU.