Ethanol ablation of small recurrent thyroid cancer – pro

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 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.”

Hay ID, Charboneau JW 2011, The Coming of Age of Ultrasound-Guided Percutaneous Ethanol Ablation of Selected Neck Nodal Metastases in Well-Differentiated Thyroid Carcinoma. J Clin Endocrinol Metab 96(9): 2717-2723

 Hay ID, Hutchinson ME, Gonzalez-Losada T, et. Al.  2008, Papillary Thyroid Microcarcinoma: A Study of 900 Cases Observed in a 60-year Period.  Surgery December 2008: 980-988.

Hay ID, McDougall IR, Sisson, J.  2008, Perspective: The Case Against Radioiodine Remnant Ablation in Patients with Well-Differentiated Thyroid Carcinoma.  The Journal of Nuclear Medicine: Vol. 49, No. 8: 1395-1397.

David S. Cooper, Gerard M. Doherty, Bryan R. Haugen, Richard T. Kloos, Stephanie L. Lee, Susan J. Mandel, Ernest L. Mazzaferri, Bryan McIver, Furio Pacini, Martin Schlumberger, Steven I. Sherman, David L. Steward, and R. Michael Tuttle. Revised American Thyroid Association management guidelines for patients with thyroid nodules  Thyroid. November 2009, 19(11): 1167-1214.

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