Paracchi A, Ferrari C, Livraghi T, Reschini E, Macchi R M, Bergonzi M, Raineri P
Servizi di Endocrinologia, Ospedale Fatebenefratelli, Milano, Italy.
J Endocrinol Invest. 1992 May;15(5):353-62. doi: 10.1007/BF03348753.
Established methods for definitive ablation of autonomous thyroid nodules are surgery and radioiodine. Since it has been demonstrated that percutaneous ethanol injection can inactivate parathyroid adenomas and small hepatocellular carcinomas, we started a trial of this treatment in patients with autonomous thyroid nodules. Twenty-eight patients, 22 toxic and 6 nontoxic, all with undetectable thyrotropin serum levels and suppressed extranodular tissue on scintigraphy, were treated. Treatment consisted of percutaneous intranodular ethanol injection under ultrasound guidance. The total amount of alcohol injected ranged from 0.4 to 2.2 times the estimated nodule volume, divided into 4 to 9 injections performed at 2 to 7 day intervals. Most patients were treated with a single cycle of injections, but 7 of them required 2 cycles. The signs and symptoms of hyperthyroidism disappeared in all cases. Apparently complete cure (normal serum free thyroid hormones, thyrotropin in basal conditions and after thyrotropin releasing hormone, reactivation of extranodular tissue on scintigraphy with nodule no longer visible) was obtained in 17 patients (13 after 1 cycle and 4 after 2 cycles). Partial cure (normal serum free thyroid hormone levels, detectable thyrotropin levels with normal or blunted response to thyrotropin releasing hormone and partial reactivation of extranodular tissue on scintigraphy with nodule or parts of it still visible) was obtained in 10 patients (8 after 1 cycle and 2 after 2 cycles). In 1 patient with a very large nodule thyrotropin levels remained undetectable, but thyroid hormone levels eventually became normal. No recurrences were observed after a follow-up of 12 to 32 months (mean 20 months). No serious side effects were encountered. A clinically valuable result was obtained in all patients. These data suggest that this form of treatment could constitute an alternative to surgery and radioiodine for the ablation of autonomous thyroid nodules.
用于彻底消融自主性甲状腺结节的既定方法是手术和放射性碘治疗。由于已经证明经皮乙醇注射可使甲状旁腺腺瘤和小肝细胞癌失活，我们开始了对自主性甲状腺结节患者进行这种治疗的试验。28例患者，22例为毒性结节，6例为非毒性结节，所有患者血清促甲状腺激素水平均不可测，闪烁扫描显示结节外组织受抑制，接受了治疗。治疗包括在超声引导下经皮向结节内注射乙醇。注射的乙醇总量为估计结节体积的0.4至2.2倍，分4至9次注射，每隔2至7天进行一次。大多数患者接受单周期注射治疗，但其中7例需要2个周期。所有病例中甲亢的体征和症状均消失。17例患者（13例在1个周期后，4例在2个周期后）实现了明显完全治愈（血清游离甲状腺激素正常，基础状态下及促甲状腺激素释放激素刺激后促甲状腺激素正常，闪烁扫描显示结节外组织重新激活且结节不再可见）。10例患者（8例在1个周期后，2例在2个周期后）实现了部分治愈（血清游离甲状腺激素水平正常，促甲状腺激素水平可测，对促甲状腺激素释放激素的反应正常或减弱，闪烁扫描显示结节外组织部分重新激活且结节或其部分仍可见）。1例有非常大结节的患者促甲状腺激素水平仍不可测，但甲状腺激素水平最终恢复正常。随访12至32个月（平均20个月）未观察到复发。未出现严重副作用。所有患者均获得了具有临床价值的结果。这些数据表明，这种治疗形式可作为手术和放射性碘治疗之外用于消融自主性甲状腺结节的一种替代方法。
