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Alcohol Sclerotherapy of Benign Thyroid Nodule

Alcohol Sclerotherapy of Benign Thyroid Nodule - What it is

​The thyroid gland is a butterfly shaped organ located in the front of the neck and produces thyroid hormones. Thyroid hormones performed a wide variety of functions including body temperature, body weight, heart rate, nervous system and the digestive tract. Over time, approximately 4-10% of the population will develop nodules (growths or lumps) in thyroid gland. The majority (95%) of thyroid nodules are benign (not cancerous) and remain stable over time. Benign thyroid nodules may be filled with fluid, be solid or partly solid and fluid. It may also represent growth of normal thyroid tissue (colloid nodule), and occasionally produce high levels of thyroid hormone (hyperfunctioning thyroid nodule). 

Alcohol Sclerotherapy of Benign Thyroid Nodule - Symptoms

​Majority of benign thyroid nodules are stable or slow-growing over time and do not cause symptoms (found incidentally). However, sometimes there may be neck pain, swallowing difficulty, foreign body sensation or cosmetic issues (visible or palpable swelling in the neck). Certain thyroid nodules may also rarely produce high levels of thyroid hormone, which can cause a wide range of symptoms including irritability, weight loss, difficulty sleeping, visual problems and heart palpitations. 

Alcohol Sclerotherapy of Benign Thyroid Nodule - How to prevent?

​There are no known measures identified to prevent benign thyroid nodules from developing in the majority of cases. However, a benign thyroid nodule which causes symptoms may benefit from an early intervention which can potentially reduce the nodule size. 

Alcohol Sclerotherapy of Benign Thyroid Nodule - Causes and Risk Factors

​The definitive causes of benign thyroid nodules have not been clearly identified. Some studies show that certain thyroid nodules may relate to smoking, obesity and metabolic syndrome or alcohol consumption (associated with thyroid gland enlargement, more so in women). Very rarely, thyroid growths may be caused by insufficient iodine in the diet, usually in the developing world. 

Alcohol Sclerotherapy of Benign Thyroid Nodule - Diagnosis

​Thyroid nodules are predominantly diagnosed by an ultrasound scan. Based on the scan result, certain thyroid nodules only require monitoring on follow-up, whereas some of them require biopsy, such as Fine Needle Aspiration Cytology (FNAC) or Core biopsy, to make a diagnosis. 

Alcohol Sclerotherapy of Benign Thyroid Nodule - Treatments

Usually malignant thyroid nodules require surgical removal. Benign thyroid cystic nodules associated with symptoms and/or cosmetic problems may be considered for treatment. One of the minimally invasive treatments is alcohol ablation of the benign thyroid cyst, known as sclerotherapy. This procedure is done under ultrasound guidance and involves using a needle(s) to remove as much of the cyst fluid as possible and injecting 99% ethanol into the cyst cavity via the same needle(s). The alcohol is left in place for a few minutes, and subsequently completely aspirated. Alcohol causes shrinkage of the thyroid cyst due protein denaturation and inflammatory fibrosis after contacting the cyst wall. 

Randomised trials of alcohol sclerotherapy have shown a greater reduction in cyst volume and lower recurrence rate compared to pure aspiration alone.

Pain during and immediately after the procedure is the major side effect of alcohol ablation. Studies have shown that up to 20 percent of patients had transient moderate to severe pain. However, this procedure is well tolerated, and is usually performed under local anesthesia. This has the additional advantage of allowing monitoring for potential nerve injury which can cause hoarseness. At the end of the procedure, the needle will be removed and the insertion site will be dressed.  You should be able to go home after 4 hours of monitoring at the Interventional Radiology Centre recovery area. 

Other available options for management of benign symptomatic thyroid nodules include radiofrequency ablation, percutaneous laser ablation (PLA), high-intensity focused ultrasound (HIFU) as well as surgery. Your doctor will discuss with you the best course of treatment in your case.



Alcohol Sclerotherapy of Benign Thyroid Nodule - Preparing for surgery

​Before the treatment, we will perform a clinical assessment for you, which include checking medical history, blood tests (clotting times, thyroid function and blood count) and ultrasound scan of the thyroid. Also, normally a biopsy (Fine Needle Aspiration Cytology (FNAC) or Core biopsy) would be performed to definitively confirm the diagnosis of a benign thyroid nodule. On the day of the procedure, you will be fasted for 6 hours prior to the time of the planned procedure. If you are on certain blood thinning medications, they may need to be stopped a few days prior to the procedure.  

Alcohol Sclerotherapy of Benign Thyroid Nodule - Post-surgery care

​After the alcohol sclerotherapy procedure, a small dressing will be placed over the site of the needle puncture, which can be removed at home in 1-2 days. You may have mild neck bruising, discomfort, swelling or pain, which will resolve in a few days. You will be able to eat, drink or carry out daily activities normally. An outpatient appointment will be given to you for post procedure follow-up. An ultrasound scan of the thyroid will be performed in about 6 months to assess nodule size reduction following the alcohol sclerotherapy.

Alcohol Sclerotherapy of Benign Thyroid Nodule - Other Information

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