First examination (first row of images):

Clinical presentation: a 67-year-old man was sent for sclerotherapy. He had a nodule in the left thyroid. It was evacuated twice but the cyst has refilled within a week at both occasions. Cytological examination was cystic lesion, not diagnostic.

Palpation: a firm nodule in the left lobe.

Functional state: euthyroidism with TSH 0.67 mIU/L.

Ultrasonography: the thyroids were echonormal. There was a cystic nodule occupying almost the entire left lobe.

We aspirated 13 ml brown fluid form the cyst. After evacuation of the cyst we gave 3.5 ml ethanol. Fever and neck pain radiating to the ear was developed the day after the first session. Analgesics had only temporary effect. We advised steroid therapy starting with 32 mg methyl-prednisone. The complaints of the patients suddenly stopped and did not recur even after ceasing the 10-day steroid administration.

Follow-up examination 31 months later (second row of images)

Clinical presentation: the patient had no complaints.

Ultrasonography: the volume of the nodule was 1/10 of the original.

Follow-up examination 6 years after sclerotherapy (second row of images)

Clinical presentation: the patient had no complaints.

Functional state: euthyroidism (TSH 1.83 mIU/L).

Ultrasonography: the volume of the nodule did not change over the past three years.

Comment: based on our previous experience with subacute thyroiditis-like reaction after sclerotherapy, we did not continue the sclerotherapy, because in most cases the treated nodule spontaneously decreases further.