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Injection of simple cysts with tetracycline as a sclerosant has been shown
to be of value for recurrent cysts (37). More recently, ethanol sclerotherapy,
with or without ultrasound guidance, has been advocated with reports suggesting
marked reduction in the size of cystic lesions on follow-up with minimal
adverse effects (38,39). Thyroxine therapy in doses which suppress serum
TSH to below the normal range has been extensively studied in terms of
its short-term and long-term effect upon goitre or nodule size. The results
of such studies have been conflicting and most show little or no benefit
from suppressive therapy (reviewed in 40), either in patients with solitary
thyroid nodules or in those with multinodular goitre. Nonetheless, T4 therapy
continues to be widely used in the hope of inducing a reduction in thyroid
size. A trial of T4-suppressive therapy, perhaps for up to one year, has
been judged to be appropriate (40), to determine if a clinically relevant
shrinkage in thyroid size results, although caution needs to be exercised
especially in postmenopausal females in whom it is possible that T4 therapy
is associated with a loss of bone mineral density and hence increased risk
of osteoporotic fracture (41).
A further non-surgical treatment option which has received recent attention is radioiodine therapy. Radioiodine treatment of multinodular goitre has been reported to induce reduction in goitre size without any short-term increase in size leading to compressive symptoms, so that radioiodine treatment has been judged to be clinically efficacious and safe, although the long-term risk of inducing hypothyroidism remains unclear (42,43). |
