Side-effects
	When PEI is performed by a skilled and experienced physician, severe adverse reactions are minimal. However, some risks may exist: Vocal cord paresis. Transient dysphonia was reported in 2–5 % of treated autonomous thyroid nodules 13 . The affected patients may have unilateral vocal cord paresis due to either the spread of ethanol outside the thyroid capsule or to nerve compression by the rapid increase of intranodular pressure. Complete recovery is obtained in the majority of patients. Persistent dysphonia due to a direct injury of the nerve has also been observed. Extra-thyroidal fibrosis due to retrograde diffusion of ethanol along the needle track. Hematomas and thrombosis. These are rare complications 13due to errors in performing the procedure (puncture of large vessels, or sudden change of needle direction) Worsening of thyrotoxicosis. PEI is followed by a transient serum thyroid hormone level increase. Severe thyrotoxicosis has been reported in few cases 9 and can be prevented by pre-treatment with thionamides (that do not affect the outcome of PEI treatment 13 ), or managed by beta-blockers administration. Hyperpyrexia, usually transient, occurs, mainly during the first ethanol injection, in 2–8 % of patients 13,15 . Brief neck pain and cervical tenderness for 24–48 hours is a common feature after ethanol injection, and may be managed by small doses of non steroidal anti-inflammatory drugs.