First investigation (first row of images)

Clinical data: a 64-year-old woman was referred for ethanol sclerotherapy. The patient was aware of a slowly growing nodule over more than 20 years. The patient suffered form cough and difficulties in swallowing for several months. These complaints were resolved for two days after aspiration of 30 mL cystic fluid for 3 weeks. However, the cyst has refilled within 2 days and her complaints have recurred. She had various diseases including ischemic heart disease, recurrent thrombotic events, therefore general anaesthesia would share a significant risk.

Palpation: a large hard nodule occupied the right lobe and the isthmus.

Functional state: euthyroidism (TSH 1.05 mIU/L).

Ultrasonography. The thyroid was echonormal. A large mixed nodule was found in the right lobe. The solid part of the lesion was echonormal, and the nodule presented signs of a type 2 vascular pattern.

27 mL cystic fluid was aspirated thereafter 7.2 mL absolute alcohol was administered. The patient had no significant complaints.

We gave six more courses of percutaneous ethanol injection.

Follow-up investigation 8 month later (second row of images)

Clinical data: the patient had no complaints.

Palpation: the nodule in the right lobe was significantly smaller compared with first examination.

Functional state: euthyroidism (TSH 0.96 mIU/L).

Ultrasonography. The thyroid was echonormal. The nodule was composed of multiple echonormal discrete lesion and lacked cystic fluid. The volume was 1/8 of the pretreatment size.

Suggestion: yearly follow-up.