Clinical presentation: A 68-year-old woman was referred for evaluation of a hypothyroidism discovered on evaluation of gastrointestinal complaints. The patient has noticed difficulties in swallowing for several months.

Palpation: Both lobes were firm. An elastic nodule was palpable in the left lobe.

Hormonal examination: hypothyroidism with TSH-level 12.9 mIU/L.

Ultrasonography. The thyroid was minimally-moderately hypoechogenic. There was a relatively large cystic nodule in the left lobe. The cyst was multichambered. The nodule presented signs of a perinodular blood flow.

A minimal amount of brown fluid was aspirated. Cytological material was scanty to give a definite diagnosis.

We gave a combined ultrasound-cytological diagnosis of cystic lesion with less than 1% risk of carcinoma.

We advised ethanol sclerotherapy. The first session of PEI was so painful that the patient decided to undergo surgery.

Histopathology disclosed benign follicular adenoma and chronic lymphocytic thyroiditis in the extranodular part of the lobe.

Comment.

1. The risk of malignancy is very low in the event of a multichambered cyst.

2. We performed ethanol sclerotherapy in more than 500 patients. Two of these patients gave up the therapy because of pain.

 

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