First session of sclerotherapy (1st row of images)

Clinical presentation: A 37-year-old woman, a teacher was referred for evaluation of a thyroid nodule. The patient was aware of the nodule for several years and she noticed a continuous increase in nodule size. Occasionally, she had complaints in recumbent position.

Palpation: a moderately firm nodule in the left lobe.

Functional state: euthyroidism (FT4 13.8 pM/L) with a subnormal TSH 0.17 mIU/L.

Ultrasonography: The thyroid was echonormal. There was a large echonormal nodule occupying almost the entire left lobe.

Scintigraphy disclosed a "cold" nodule. Aspiration cytology resulted in benign cystic lesion.

The patient wished to avoid surgery and choose sclerotherapy instead.

Six sessions of ethanol were administered. 17.4 mL alcohol was given in all.

Follow-up investigations 6 weeks after the last session (second row of images):

Clinical presentation: The patient felt that the nodule decreased.

Palpation: unchanged.

Functional state: euthyroidism (TSH 1.58 mIU/L).

Ultrasonography. The nodule significantly decreased in size and became moderately hypoechogenic.

Follow-up investigations 4 months after the last session (third row of images):

Clinical presentation: The patient had no complaints.

Palpation: unchanged.

Functional state: euthyroidism (TSH 0.76 mIU/L).

Ultrasonography. The size of the nodule did not change significantly in the previous months.

Follow-up investigations 2 years after the last session (third row of images):

Clinical presentation: The patient had no complaints.

Palpation: unchanged.

Functional state: euthyroidism (TSH 0.59 mIU/L).

Ultrasonography. The size of the nodule increased by 50% but was already one quarter of the pretreatment volume.

We met the patient another two years later when the size of the nodule was unchanged.

Follow-up investigations 11 years after the last session (fifth row of images):

Clinical presentation: The patient requested evaluation because of neck discomfort developed in the past two years.

Palpation: unchanged.

Functional state: euthyroidism (TSH 0.86 mIU/L).

Ultrasonography. The size of the nodule reached the original, pretherapy volume. It was composed of multiple echonormal discrete lesions.

We offered to undergo either surgery or repeat ethanol sclerotherapy.

Comment. The main problem with sclerotherapy of solid nodules is the relatively low long-term success rate. Nevertheless, the 10-year success rate is above 60% in our practice. Moreover, the statistical and the practical success rate differs significantly. The former means that the volume of the nodule is less than 50% of the original volume while the latter means that the nodule is larger than this cut-off level but the nodule does not cause compression signs.