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Percutaneious Ethanol Injection (PEI) ? ...
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Percutaneious Ethanol Injection (PEI) ? ...

Dear Dr. Lupo,

Thank you so much for all you do helping our members of your Expert Forum as well as the members of our Thyroid Disorders Community .. we reference your community oftentimes for our members, and thank you.

What is your opinion as it relates to a procedure called Percutaneious Ethanol Injuection (PEI) for thyroid cysts?  

From what our community has heard, (and please correct me if I'm wrong), this procedure is still not widely used?

Can some patients who have benign cysts avoid surgery and use this procedure instead?

What is your opinion on PEI & do you think it can provide relief for these who want to get rid of unsightly or compressive cysts but cannot afford or do not want surgery?    

We really appreciate and value your opinion, Dr. Lupo, as this question is sometimes asked on the community and we'd like to reference this post in our Health Pages.

Holiday Wishes,

Co Community Leader:  Thyroid Disorders


For those not familiar with PEI the full abstract article source is:

Ethanol Ablation Safe, Effective for Thyroid Cystic Nodules
Laurie Barclay, MD

Endo 2003: Abstracts OR10-1, OR10-2. Presented June 19, 2003

Related Discussions
PEI can be very effective in the treatment of larger cysts that have one significant pocket of fluid (in contrast to multiple, small pockets of fluid) -- The cyst is drained then approx half of that volume in 95% ethanol is injected back into the cyst.  Risks include extravasation of the ethanol into the local tissues with possible damage to the nerve going to the vocal cords (usually temporary).  There are a few of us who perform these on a regular basis, but it is still not widely available.   In many cases, it can prevent the need for surgery.
Dr Lupo,

Is there a treatment center or doctor that you would recommend in the NYC/Tri-state area that can perform this procedure?

I have a TGDC for as long as I can remember, but am considering this procedure as a way to avoid surgery.

Appreciate your help in this matter.

There is limited experience/success with TGD cysts for this procedure.  Would consider Bob Levine in New Hampshire.  Don't know anyone else in the general area.
Mark, really appreciate you spending the time to answer our questions.  You're really doing a great service to the community.

I have a question about how PEI actually works.  PEI will not eradicate the cyst correct?  It just shrinks the cyst to 1/10 or less of it's original mass?  Does the cyst kind of dry up like a raisin?

I don't have Aetna, but their policy states the following criteria for coverage.  Was wondering if I do fit the criteria below, if there is a high probability of success with PEI for treatment of my TGDC.



  1.Aetna considers ethanol injection sclerotherapy medically necessary for the treatment of thyroglossal duct cysts when all of the following selection criteria are met:
         1. Cytologic studies show that the lesion is benign; and
         2. Cystographic studies indicate that there is no extravasation; and
         3. A monocystic lesion is present.

      Note: It may be medically necessary to repeat injections after 1 month in cases of recurrence of cyst.
   2.Aetna considers ethanol injection sclerotherapy of thyroglossal duct cysts experimental and investigational when these criteria are not met.
   3.Aetna considers percutaneous ethanol injection experimental and investigational for the treatment of thyroid cancer because its effectiveness for this indication has not been established.

A related discussion, ethanol eblation was started.
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