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Percutaneous Ethanol Injection plus Radioiodine Versus Radioiodine Alone in the Treatment of Large Toxic Thyroid Nodules

¹ Unità di Endocrinologia, Scientific Institute "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
² Centro di Riferimento Oncologico Regionale della Basilicata, Rionero in Vulture, Italy
³ Servizio di Medicina Nucleare, Scientific Institute "Casa Sollievo della Sofferenza," San Giovanni Rotondo, Italy
⁴ Istituto di Clinica Medica Università di Foggia, Foggia, Italy
⁵ Dipartimento di Scienze Cliniche, Università di Roma "La Sapienza," Rome, Italy

Therapeutic options for toxic thyroid nodules (TTNs) are surgery, radioiodine (RAI), and percutaneous ethanol injection (PEI). Surgery is generally considered for TTNs larger than 4 cm. However, some patients may be at high surgical risk. The purpose of the study was to evaluate the efficacy of 2 nonsurgical modalities for these TTNs. Methods: Twenty-two patients with TTNs larger than 4 cm were randomly assigned to 2 different treatments: to 11 (subgroup A), RAI was administered at a dose of 12,580 kBq/mL of nodular volume (NV) and was corrected for 100% 24-h ¹³¹I uptake (RAIU); to 11 (subgroup B), 2–4 PEI sessions (ethanol injected = 30% NV) preceded 2 mo of 24-h RAIU and RAI dosing. Inclusion criteria were clinical and biochemical hyperthyroidism; a single palpable, hot nodule at ^99mTc scintigraphy; and high surgical risk or refusal to have surgery. Patients gave informed consent. Local symptoms were evaluated by a previously validated score (symptom score, or SYS). Results: Both treatments were well tolerated. Subgroup B showed a significant reduction of NV 2 mo after PEI: 33.6 ± 18.5 versus 60.8 ± 29.5 mL. Their 24-h RAIU was similar to that of subgroup A: 53.9 ± 13.9 versus 61.8% ± 11.0%. Consequently, the administered RAI dose was significantly lower for subgroup B (730 ± 245 MBq) than for subgroup A (1,048 ± 392 MBq). Twelve months after RAI, subgroup B had a higher NV reduction and a lower SYS than did subgroup A. In subgroup A, 1 patient was subclinically hyperthyroid, 2 showed a slight increase of thyroid-stimulating hormone, and 1 was clinically hypothyroid. In subgroup B, 1 patient had a slight increase of thyroid-stimulating hormone. Conclusion: We demonstrated that RAI, alone or with PEI, can be considered a valid alternative for TTNs larger than 4 cm when surgery is either refused or contraindicated. PEI plus RAI can be considered when marked shrinkage of a nodule is required or when reduction of the RAI dose can prevent hospitalization.

Key Words: toxic thyroid nodules • radioiodine treatment • alcohol ablation • interventional procedures

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				A. Iagaru and I. R. McDougall Treatment of Thyrotoxicosis J. Nucl. Med., March 1, 2007; 48(3): 379 - 389. [Abstract] [Full Text] [PDF]

				F. Pacini Role of Percutaneous Ethanol Injection in Management of Nodular Lesions of the Thyroid Gland J. Nucl. Med., February 1, 2003; 44(2): 211 - 212. [Full Text] [PDF]