The thyroid is a butterfly-shaped endocrine organ that produces thyroid hormones. It is in the lower half of the neck, draping over the trachea (airway). Nodules, or collections of thyroid cells forming a “lump,” may develop inside the thyroid.

Thyroid nodules are very common and develop as patients get older. Up to 60% of people will develop nodules in the thyroid gland at some point in their lives. Most nodules are non-cancerous, do not alter thyroid function and don’t require treatment. If nodules grow, cause hyperthyroidism or pose a cancer risk, then treatment is usually recommended.

Thyroid Cyst Treatment – Ethanol Ablation

When the nodules are filled with fluid, they are called cysts. Pure cysts with no solid component are nearly always non-cancerous. Some thyroid cysts may grow over time, become visible or press on nearby structures. They could also cause symptoms such as difficulty swallowing or breathing or cause a tight feeling in the neck. If you experience these symptoms, speak to your health care provider for an evaluation and possible treatment of a thyroid cyst.

Common treatment for thyroid cysts

In the past, treatment of small cysts consisted of removing the fluid from within the cyst using a small needle (aspiration) under ultrasound guidance. However, aspiration alone often results in reaccumulation of fluid, especially with larger thyroid cysts. The other option for treatment is to surgically remove one side of the thyroid gland. Some patients require thyroid hormone supplementation after this procedure.

How ethanol ablation works

It is now easier than ever to treat thyroid cysts without surgery by injecting ethanol into the cyst. Endocrine surgeon Barbra Miller, MD, from the Division of Surgical Oncology, has performed this office-based procedure for over a decade.

Ethanol ablation can be performed on just about any size thyroid cyst, even those that are very large. Large cysts may require an additional session for treatment, but surgery can still be avoided.

What to expect during ethanol ablation

Patients will undergo ultrasound examination in the office first. We do this to determine whether the cyst has a significant solid component. If it does, we typically suggest a fine needle aspiration biopsy to rule out thyroid cancer.

In general, if the cyst is more than 80% fluid and there are no signs of thyroid cancer, ethanol ablation can be performed. The procedure itself usually only takes about five minutes.

Under ultrasound guidance, we insert a very small needle to numb the area around the cyst. We then insert a needle to drain the existing fluid out of the cyst. Next, we inject the resulting space with ethanol. This causes a reaction with the inner lining of the cyst wall and prevents fluid from reaccumulating. It allows the area to shrink significantly.

During the injection, patients are asked if they’re experiencing any significant pain. If they are, it may mean ethanol has leaked outside the nodule. The procedure is halted to ensure ethanol is only being injected into the cyst cavity. This rarely happens.

Patients do not need to do anything ahead of time to prepare for ethanol ablation. The procedure is performed in an outpatient setting with a small amount of local anesthetic. There is no need for a hospital setting, and there is minimal discomfort — usually no more than that of a bee sting when the local anesthetic is injected.

Recovering from ethanol ablation

There are no restrictions from any activities after ethanol ablation of a thyroid cyst. Bruising or redness at the injection site may occur and generally fades quickly. Patients are provided with an ice pack. Over-the-counter medications such as acetaminophen or ibuprofen are recommended to ease any discomfort. Patients are seen back in the office about three months later to reassess the size of the cyst.

Patients on blood thinners are instructed to stop taking these medications in advance of the procedure; however, it is okay to continue aspirin. Blood thinners may be restarted the day after the procedure if there is no evidence of an obvious hematoma (collection of blood).

There is a very low risk of bleeding, infection or soft tissue damage as a result of the procedure (<1%), and there are fewer risks compared to thyroid surgery.

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