Alcohol injection for small thyroid cancers

Recurrent thyroid cancer can present as isolated localized nodules, which may persist for a long time, and may conceivably not require systemic treatment. Alcohol ablation involves injecting small recurrent thyroid cancers with alcohol using imaging such as ultrasound for placement. This procedure was pioneered at Mayo clinic and is not universally available. The concept is that this procedure can produce long term control or cure of such isolated recurrences. The Thyroid Associations guideline of 2009 says: “Data supporting the safety and efficacy of such techniques come largely from outside the United States). Long-term follow-up exists to 5 years, showing that PEI is effective and safe. In a large series of 125 patients, Tarantino et al. demonstrated an overall cure rate (absent uptake in the nodule) of 93%, and a major complication rate of 3%. These included transient laryngeal nerve damage, abscess, and hematoma. All patients remained euthyroid (low/normal TSH and normal free T3 and free T4 estimates) during follow-up. The average reduction in the volume of nodules after PEI was 66%. Given the relative lack of experience with these alternative techniques, 131I therapy and surgery remain the mainstay of treatment. PEI or alternative treatments should be employed only in the very rare situation when standard therapies have failed, or are contraindicated or refused.”

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