Radioiodine and Percutaneous Ethanol Injection in the Treatment of Large Toxic Thyroid Nodule: A Long-Term Study
Abstract
Surgery is generally recommended for large thyroid toxic nodules (TTNs). When surgery is not applicable, both radioactive iodine (RAI) and percutaneous ethanol injection (PEI) are alternative treatments. In this retrospective study, the long-term efficacy of nonsurgical treatments was evaluated in 43 patients with TTN, selected on the basis of presence of hyperthyroidism and a fairly large nodule (3- and 4-cm in diameter) completely inhibiting controlateral lobe captation during scintigraphy. Twenty-one patients were treated by RAI (administered dose 670+/-160 MBq; range 555-925) and twenty-two were treated by PEI (6+/-1 sessions; range 5-9). FT4, FT3, thyrotropin (TSH), and nodule volume were assessed before and at fixed intervals after treatment. Median follow-up was 36 months (range, 12-84). Compared to baseline values, with both therapies, serum FT4, FT3, and nodule volume were decreased (p < 0.01) and serum TSH was increased (p < 0.01), after 3 months and during the entire follow-up. Nodule volume reduction percentage was 66.8+/-22.0 and 78.4+/-18.0, in the RAI- and PEI-treated groups, respectively. At the end of follow-up, 34 patients were euthyroid (16 RAI- and 18 PEI-treated). Four RAI-treated patients (19%) showed slightly high TSH levels (4.2-5.3 mU/L), whereas three PEI-treated patients (13.6%) still had suppressed TSH levels, although being clinically asymptomatic. One RAI-treated patient (4.8%) showed overt hypothyroidism during the follow-up period and was then treated with L-thyroxin. One patient (4.6%), who was initially cured by PEI, became newly hyperthyroid during the follow-up period. Both treatments were well-tolerated. In conclusion, both of these nonsurgical treatments are effective and may be chosen also for relatively large TTNs. Specifically, RAI seems to be more effective for treating hyperthyroidism but has minimal sequelae of subclinical or clinical hypothyroidism, while, after PEI treatment the possibility of stable subclinical hyperthyroidism or hyperthyroidism relapse should be taken into account.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Reports supporting the efficacy of percutaneous ethanol injection under sonographic guidance to treat TA and TMNG come largely from Europe.
“Reports that support the efficacy of percutaneous ethanol injection under sonographic guidance to treat TA and TMNG come largely from Europe (299-301).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [301]
Ethanol ablation has been used following RAI to reduce nodule size.
“Ethanol ablation also has been used following RAI to reduce nodule size (301).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [301]
Cites
Management of a Solitary Thyroid Nodule
Desforges, J. F., & Mazzaferri, E. L. (1993) · New England Journal of Medicine · doi:10.1056/nejm199302253280807 · Cited by 1,422 · see citing works
Low Serum Thyrotropin Concentrations as a Risk Factor for Atrial Fibrillation in Older Persons
Sawin, C. T., Geller, A., Wolf, P. A., Belanger, A. J., Baker, E., Bacharach, P., Wilson, P., Benjamin, E. J., & D'Agostino, R. B. (1994) · New England Journal of Medicine · doi:10.1056/nejm199411103311901 · Cited by 1,259 · cited 1× · see citing works
“The persistence of sub¬ clinical hyperthyroidism after PEI requires further longitudinal investigation and, at least for older patients, may constitute a risk factor for osteoporosis or atrial fibril¬ lation (22-23).”
Faber, J., & Galløe, A. M. (1994) · European Journal of Endocrinology · doi:10.1530/eje.0.1300350 · Cited by 377 · see citing works
Is calculation of the dose in radioiodine therapy of hyperthyroidism worth while?
Jarløv, A. E., Hegedüst, L., Kristensen, L. Ø., Nygaard, B., & Hansen, J. (1995) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1995.tb02039.x · Cited by 155 · see citing works
Nygaard, B., Hegedüs, L., Gerhard Nielsen, K., Ulriksen, P., & Hansen, J. M. (1999) · Clinical Endocrinology · doi:10.1046/j.1365-2265.1999.00635.x · Cited by 148 · see citing works
Lippi, F., Ferrari, G. C., Manetti, L., Rago, T., Santini, F., Monzani, F., Bellitti, P., Papini, E., Busnardo, B., Angelini, F., et al. (1996) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.81.9.8784080 · Cited by 136 · see citing works
Treatment of autonomous thyroid nodules with percutaneous ethanol injection: 4-year experience.
Livraghi, T., PARACCHI, A., Ferrari, G. C., Reschini, E., Macchi, R. M., & Bonifacino, A. (1994) · Radiology · doi:10.1148/radiology.190.2.8284411 · Cited by 120 · see citing works
Solitary Autonomously Functioning Thyroid Nodules and Iodine Deficiency*
BELFIORE, A., SAVA, L., RUNELLO, F., TOMASELLI, L., & VIGNERI, R. (1983) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-56-2-283 · Cited by 104 · see citing works
Follow-up of Solitary Autonomous Thyroid Nodules Treated with 131I
Goldstein, R., & Hart, I. R. (1983) · New England Journal of Medicine · doi:10.1056/nejm198312153092401 · Cited by 104 · see citing works
Incidence of hypothyroidism occurring long after iodine-131 therapy for hyperthyroidism.
Holm, L., Lundell, G. E. F., Israelsson, A., & Dahlqvist, I. (1982) · PubMed · Cited by 100 · see citing works
The Autonomously Functioning Thyroid Nodule: Goetsch's Disease
Hamburger, J. I. (1987) · Endocrine Reviews · doi:10.1210/edrv-8-4-439 · Cited by 91 · see citing works
Ross, D. S., Ridgway, E. C., & DANIELS, G. H. (1984) · Annals of Internal Medicine · doi:10.7326/0003-4819-101-4-488 · Cited by 90 · see citing works
Treatment of the autonomous thyroid nodule: a review
Ferrari, C., Reschini, E., & Paracchi, A. (1996) · European Journal of Endocrinology · doi:10.1530/eje.0.1350383 · Cited by 85 · see citing works
The different types of hyperthyroidism in Europe. Results of a prospective survey of 924 patients
REINWEIN, D., Benker, G., König, M. P., Pinchera, A., Schatz, H., & Schleusener, A. (1988) · Journal of Endocrinological Investigation · doi:10.1007/bf03350134 · Cited by 82 · see citing works
Radiation Dose in the Selection of 131I or Surgical Treatment for Toxic Thyroid Adenoma
Gorman, C. A., & ROBERTSON, J. S. (1978) · Annals of Internal Medicine · doi:10.7326/0003-4819-89-1-85 · Cited by 65 · see citing works
Long-term follow-up in toxic solitary autonomous thyroid nodules treated with radioactive iodine.
Huysmans, D. A., Corstens, F. H. M., & KLOPPENBORG, P. W. C. (1991) · PubMed · Cited by 59 · see citing works
Mariotti, S., Martino, E., Francesconi, M., Ceccarelli, C., Grasso, L., Lippi, F., Baschieri, L., & Pinchera, A. (1986) · European Journal of Endocrinology · doi:10.1530/acta.0.1130500 · Cited by 56 · see citing works
Kinser, J. A., Roesler, H., Furrer, T., Grütter, D., & Zimmermann, H. (1989) · PubMed · Cited by 29 · see citing works
Zingrillo, M. (1998) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.83.11.3905 · Cited by 26 · see citing works
Self-citationNygaard, B., Jarløv, A. E., Hegedűs, L. D., Schaadt, B. K., Kristensen, L. Ø., & Hansen, J. (1994) · Thyroid · doi:10.1089/thy.1994.4.167 · Cited by 12 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“Ethanol ablation also has been used following RAI to reduce nodule size (301).”
MethodTarantino, L., Francica, G., Sordelli, I., Sperlongano, P., Parmeggiani, D., Ripa, C., & Parmeggiani, U. (2008) · American Journal of Roentgenology · doi:10.2214/ajr.07.2668 · Cited by 67 · see citing works
- Authors
- Zingrillo, M., Torlontano, M., Ghiggi, M. R., Frusciante, V., Varraso, A., Liuzzi, A., & Trischitta, V.
- Affiliations
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Casa Sollievo della Sofferenza (IT)
- IRCCS Istituto Auxologico Italiano (IT)
- ORCID
- Trischitta, Vincenzo
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2000-11
- Volume
- 10
- Issue
- 11
- Pages
- 985-989
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2078602185
- Cited by
- 54
- References
- 20
- Citations by year
- 2026: 1 · 2024: 2 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 2 · 2015: 1 · 2013: 1 · 2012: 2
- FWCI
- 2.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- radioiodine therapy, percutaneous ethanol injection, hyperthyroidism, nodule volume reduction, TSH suppression, subclinical hypothyroidism, subclinical hyperthyroidism, conservative treatment, long-term efficacy, thyroid scintigraphy, nontoxic goiter, thyroidectomy avoidance, overt hypothyroidism, thyroxine replacement
- MeSH terms
- Adult, Aged, Ethanol, Female, Follow-Up Studies, Humans, Hyperthyroidism, Iodine Radioisotopes, Male, Middle Aged, Radionuclide Imaging, Recurrence, Retrospective Studies, Solvents, Thyroid Hormones, Thyroid Nodule, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
