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PEI represents a useful alternative to thyroid
surgery or radioiodine administration, especially
in geographical areas devoid of nuclear medicine
facilities. However, it should be pointed out that
PEI for thyroid nodules is not completely devoid
of side effects, that can be minor and transient
(local or irradiated pain, fever, dysphagia) or
relevant, such as dysphonia, albeit also usually
transient. Therefore, this technique should be
restricted to benign nodules with a complete and
intact capsule and carried out by a well trained
physician exclusively under sonography guid-ance.
Patients with pre-toxic or toxic adenomas
should be pretreated with thionamides that
deplete nodular storage of thyroid hormones and
avoids transient thyrotoxicosis due PEI-induced
thyroid tissue destruction; moreover, methima-zole
does not affect successful outcome of PEI
treatment. Afurther word of caution relates to the
lack of long-term follow-up studies evaluating
both the occurrence of hypothyroidism and the
recurrence of thyroid ”hot” nodules.
Isolated and small thyroid cysts may be success-fully treated by ethanol injection, thus represent-ing a good alternative to surgery or intranodular injection of sclerosing substances such as tertra-cycline. Considering that L-T 4 suppressive ther-apy for cystic lesions is hardly if ever effective, PEI might be seen as a first-line treatment in the non-surgical management of single thyroid cysts. As pointed out in other sections of this review, a benign cytology is required before PEI treatment. Thyroidectomy after PEI treatment of pre-toxic or toxic thyroid nodules, albeit conducted in few cases, was not associated with a greater risk of side-effects 33 ; histology showed no significant fibrosis or adhesion outside the thyroid capsule, suggesting that subsequent surgical treatment after PEI is feasible, if necessary. In addition, because only scant data are available so far on the use of PEI for the treatment of soli-tary benign cold solid nodules, further results have to be awaited before a definite place of PEI for this condition can be decided on. Finally, we recommend to avoid PEI treatment for toxic- or non toxic multinodular or diffuse goiter. |
