Ethanol/Alcohol Ablation

[aubie8]

I'm a 30YO F in Alabama and recently diagnosed with hot nodules and clinical hyperthyroidism.

I do not want RAI therapy or surgery for fear of hypothyroidism. I have a very active lifestyle and fear the consequences of hypo would drive me insane.

I have read a lot about ethanol injections (PEI) for hot nodule treatment. The results seem AMAZING. Almost like a true cure, although I do understand there can be some side effects: burning, pain, etc. I am more than willing to try this form of treatment.

It does not seem to be widely practiced here in the U.S. Is this treatment readily available? FDA approved?

My doctor seems set on RAI and I want to know if this is a realistic/available treatment. I plan on trying medication since my symptoms are not severe and am willing to wait for this to be more prominent if it is not already.

Thoughts?

Many thanks!
Tiff

[Mark Lupo, M.D.]

There is no one in the USA doing PEI for hot nodules -- the initial studies from europe looked promising, but larger studies did not pan out well.

RAI is the standard of care, but has a high (at least 50%) chance of hypothyroidism.  Total thyroidectomy is usually done if both lobes have hot nodules - this guarantees hypo.   A lobectomy (removing one lobe) is done if only one lobe has hot nodule(s) -- about 30% chance of hypothyroidism.

Hypothyroidism is usually readily treated with levothyroxine with good success.

The only other option is minimally invasive radio-guided selective thyroidectomy (MIRST) -- this uses sestamibi (nuclear medicine) to help the surgeon selectively removed only the hot nodules and leave the normal thyroid behind -- I have had 2-3 patients do this and they are doing very well.  The only person I know who is doing this is Dr. Jim Norman in Tampa (he's a well-known parathyroid surgeon -- www.parathyroid.com).  It is not yet widely accepted, but makes sense as an alternative approach to this problem.