First session of sclerotherapy (first row of images):

Clinical presentation: a 36-year-old woman was send to sclerotherapy from another institute. She was diagnosed with an autonomously functioning adenoma on evaluation of hyperthyroidism (TSH 0.01 mIU/l, FT4 36.5 pM/L). The patient proved to be allergic both to methimazole and propyl-thioracil. Radioiodine therapy was planned but the patient became pregnant.
At present investigation she suffered from tachycardia, sweating, and tremor. She was on the 9th week of her pregnancy.

Palpation: an elastic nodule in the right lobe.

Hormonal investigation indicated hyperthyroidism (TSH 0.001 mIU/l, FT4 37.0 pM/L).

Ultrasonography: the thyroid was echonormal. There was a mixed echonormal-cystic nodule in the right lobe.

Three sessions of sclerotherapies were performed within 15 days. At first occasion we aspirated 2.2 mL brown fluid from the nodule.

6 weeks after the last session (second row of images):

Clinical presentation: the complaints of the patient have stopped after the second sclerotherapy.

Hormonal investigation indicated euthyroidism (TSH 1.13 mIU/L, FT4 15.7 pM/L).

Ultrasonography: the nodule in the right lobe decresed significantly in volume.

Suggestion: dTSH and ultrasound examination every 2 months until delivery.

6 months after the last session (third row of images):

Clinical presentation: the patient delivered a healthy child 3 months prior the present examination. She had no complaints.

Hormonal investigation indicated euthyroidism (TSH 1.99 mIU/L, FT4 15.1 pM/L).

Ultrasonography: the nodule decreased further.

10 years after the sclerotherapy (fourth row of images):

Clinical presentation: the patient was regularly checked in every teo year. The size of the nodule was in the range of 0.39 to 0.78 mL. The TSH and FT4 levels wer always normal.

Hormonal investigation indicated euthyroidism ( TSH 2.84 mIU/l, FT4 13,6 pM/L).

Ultrasonography. The nodule was composed of two smaller partly cystic lesions.

Suggestion: repeat TSH and ultrasound in 3 years.

Comment. This is the only patient in our practice who was sclerotized within the first 12 weeks of pregnancy. She suffered from complaints linked unequivocally to hyperthyroidism.