Treatment of hyperfunctioning thyroid nodules by percutaneous ethanol injection

BACKGROUND: Autonomous thyroid nodules can be treated by a variety of methods. We assessed the efficacy of percutaneous ethanol injection in treating autonomous thyroid nodules. METHODS: 35 patients diagnosed by technetium-99 scanning with hyperfunctioning nodules and suppressed sensitive TSH (sTSH) were given sterile ethanol injections under ultrasound guidance. 29 patients had clinical and biochemical hyperthyroidism. The other 6 had sub-clinical hyperthyroidism with suppressed sTSH levels (<0.24 μIU/ml) and normal thyroid hormone levels. Ethanol injections were performed once every 1–4 weeks. Ethanol injections were stopped when serum T(3), T(4 )and sTSH levels had returned to normal, or else injections could no longer be performed because significant side effects. Patients were followed up at 3, 6 and, in 15 patients, 24 months after the last injection. RESULTS: Average pre-treatment nodule volume [18.2 ± 12.7 ml] decreased to 5.7 ± 4.6 ml at 6 months follow-up [P < 0.001]. All patients had normal thyroid hormone levels at 3 and 6 months follow-up [P < 0.001 relative to baseline]. sTSH levels increased from 0.09 ± 0.02 μIU/ml to 0.65 ± 0.8 μIU/ml at the end of therapy [P < 0.05]. Only 3 patients had persistent sTSH suppression at 6 months post-therapy. T(4 )and sTSH did not change significantly between 6 months and 2 years [P > 0.05]. Ethanol injections were well tolerated by the patients, with only 2 cases of transient dysphonia. CONCLUSION: Our findings indicate that ethanol injection is an alternative to surgery or radioactive iodine in the treatment of autonomous thyroid nodules

Thermal Ablation for Benign Thyroid Nodules: Radiofrequency and Laser

Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation

A combined Montecarlo/GEVT extrapolating method for the estimate of buffer length distribution tails

This paper deals with the application of Generalized Extreme Value Theory (GEVT) to the ATM buffer dimensioning. In particular, a general ATM system simulation model has been defined in order to analyze a large variety of buffer behaviours. The performance of the classical GEVT estimate procedure are evaluated in some critical cases by stressing its limits. In order 10 better cope with these cases, a modified version of the GEVT estimate procedure is proposed. Such a procedure is based on the combined utilization of the knowledge obtained from the classical Montecarlo method and the extrapolating form of the GEVT estimator. The obtained results show that this method allows some limitations of the GEVT approach to be overcome and a very good result accuracy can be reached

Cold benign thyroid nodule volume reduction predictability after percutaneous ethanol injection

Objective: To determine the effect of percutaneous ethanol injection (PEI), a suppressive therapy for cold benign thyroid nodules (CBNs), on cytology. Study Design: The study group consisted of 31 CBNs, treated with PEI for 1 year, aspirated before and while the patients were on suppressive therapy. A control group consisting of 22 patients, whose nodule characteristic, PEI treatment and follow-up were similar to those of the study patients group, was monitored to confirm the results. By analogy with a similar study, the following factors were considered: an initial volume of the CBNs &gt; 25 mL, abundant colloid, degree of cellular hyperplasia and presence of degenerative changes. To verify these hypotheses, we tested the differences using the t test for the initial volume and the Mann-Whitney U test for the remaining features. Results: The study has proved the unpredictability of the volume reduction in a single nodule on the basis of cytologic evaluation. Conclusion: The lack of cytologic features that can be considered statistically predictive of large nodule reduction as a result of PEI treatment confirms that fine needle aspiration cytology may help establish the correct diagnosis. © The International Academy of Cytology