Alcohol is a material that can kill tumor cells by changing the structure of their proteins (denaturation). In the thyroid, it was first used by Dr Livraghi successfully for the treatment of a toxic nodule, and since then, it has become one of the options for such nodules. Later, it was also utilized for nontoxic benign thyroid nodules with favorable results. In 1994, Dr Verde performed alcohol ablation for a cystic thyroid nodule, which disappeared completely after the treatment. Because of these successful results, alcohol ablation has become one of the most popular treatment options especially for cystic or predominantly cystic benign thyroid nodules.
How is alcohol ablation done?
First, an ultrasound examination is done and the target nodule is visualized. Then, the skin is numbed and under ultrasound guidence, a thin needle is placed into the nodule. If the nodule is solid, alcohol is slowly injected into the different parts so that it infiltrates the tissue diffusely. If the nodule is cystic (containing fluid), first the fluis is aspirated and then, alcohol is injected. After the procedure, the patient is observed for about one hour and then, discharged.
Which type of nodules are suitable for alcohol ablation?
Alcohol ablation is considered the first line therapy for cystic nodules of the thyroid. It is as successful as laser and radiofrequency in the treatment of predominantly cystic nodules. It can also be used in solid nodules, but in such cases, alcohol ablation is technically more challenging and should be performed only in experienced centers. After alcohol ablation, the destroyed nodule becomes smaller in size, and this shrinkage continues for months.
Besides the benign nodules, alcohol ablation has also been successfully used in the treatment of recurrent lymph node metastases of thyroid cancers. The technique is considered a good alternative in patients who are not suitable for or do not want surgery. But the lymph nodes to be treated must be clearly visible on ultrasound.
What are the advantages of alcohol ablation?
It is performed with a very tiny needle under local anesthesia. It causes no scar on the neck and the patient may go home one hour after the procedure.
Our patient with 4 thyroid nodules (the largest one: 44x34x27mm, the nodules contained cystic areas): Alcohol ablation was done for all the nodules, which shrank subsequently. On 12 months ultrasound control, the largest nodule showed 85% volume reduction.
In our 32 year-old male patient with a 62x50x47 mm semisolid thyroid nodule, ultrasound-guided alcohol ablation were done 2 times with 3 months apart. One year after the first ablation, a 90% volume reduction was seen on ultrasound.
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