cyst below thyroid lobe

[comfycouch]

hi
am a 40 old women ,
i have a3cm cyst below are on thyroid lobe i was wondering  if this should be look at by a specialist .
what do you think , do i need a biopsy done.
are should waite. please write back i'm realy worried
thx

[898]

If the cyst is simple it will be aspirated and sample would be checked for malignancy;
If cyst re-grows, the PEI may be in order

[Mark Lupo, M.D.]

Yes you need a biopsy and consultation with a thyroid specialist (endocrinologist).

[898]

Source:
"Percutaneous Ethanol Injection for Benign Cystic Thyroid Nodules: Is Aspiration of Ethanol-Mixed Fluid Advantageous?"
**** Wook Kima, Myung Ho Rhoa, Hak Jin Kimb, Jae Su Kwona, Young Sun Sunga and Sang Wook Leea
a] From the Department of Radiology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, South Korea
b] Department of Radiology, Pusan National University Hospital, South Korea

2005

[898]

The PEI stays for "percutaneous ethanol injection" it fully described in the article below:
  "The cystic portion of thyroid nodules is considered to be caused by hemorrhage and subsequent degeneration of preexisting nodules (1). Several methods for treating benign cystic thyroid nodules, such as fine-needle aspiration, thyroid hormone suppression therapy, and sclerotherapy with various sclerosants have been introduced (9–14). Among these methods, simple fine-needle aspiration has been shown to have a high recurrence rate of 58% (1,6). Thyroid hormone suppression therapy has been found to have little effect on benign thyroid nodular disease (11). Sclerotherapy with ethanol, tetracycline, or OK-432 is effective to treat cystic thyroid nodules, and the effectiveness of ethanol is similar to that of tetracycline and OK-432 for percutaneous ethanol injection of cystic thyroid nodules, despite its lower cost and ease of repetition (5). Since introduction of percutaneous ethanol injection to treat thyroid cysts in the early 1980s, there have been many studies of the effectiveness of percutaneous ethanol injection in treating cystic thyroid nodules (1–7). Sonographically guided percutaneous ethanol injection for autonomously functioning thyroid nodules was first introduced in 1990 by Livraghi et al (15). The sclerotic mechanism of ethanol is cellular dehydration and protein denaturation in tissue, followed by coagulation necrosis, small vessel thrombosis, hemorrhagic infarct, and reactive fibrosis (15).

Although percutaneous ethanol injection is the most commonly used therapeutic method for treating cystic thyroid nodules in the world, some authors insist on complete evacuation of infused ethanol for prevention of ethanol leakage or other potential complication (6–8), whereas others prefer nonaspiration of infused ethanol for simplicity (1–5). Percutaneous ethanol injection without aspiration of infused ethanol seems to be more popular in recently published articles, whereas Bennedbaek and Hegedus (7) recommended complete aspiration of infused ethanol because of paraglandular fibrosis, caused by ethanol escaping outside the capsule. However, to our knowledge, no studies of the differences between aspiration and nonaspiration of infused ethanol have been found. In our study, a significant difference between the 2 methods was not observed in terms of successful results with complete disappearance of the cystic portion of the thyroid nodule.

Yasuda et al (1) and Cho et al (4) reported that with ethanol sclerotherapy, the cystic volumes decreased by more than half in 72% and 68% of the patients they treated for recurrent thyroid cyst after fine-needle aspiration. In our study, most thyroid nodules had complete disappearance of the cystic portion after percutaneous ethanol injection, as observed on the first follow-up ultrasonography; they showed progressively decreased size or nearly complete obliteration on long-term follow-up ultrasonography for a 1-year period. We obtained excellent results (95%, 3/60) without recurrence in both study groups (0%, 0/57).

Many authors recommend a maximum amount of infused ethanol of 10 mL in sclerotherapy of benign thyroid cysts (1–3,6–7). In our study, the total amount of infused ethanol did not exceed 20 mL in any patient, except for one group B patient, and if the first aspirates were <10 mL, nearly the same amount of ethanol was instilled.

Many complications, such as pain, facial flushing, a drunken sensation, headache, mild dizziness, perithyroidal or perinodal ethanol leakage, intracystic hemorrhage, local hematoma, secondary infection, or vocal cord paralysis, can occur during or after percutaneous ethanol injection for cystic thyroid nodule. In this report, no significant statistical differences were observed between 2 groups, except for intracystic hemorrhage during the procedure. Intracystic hemorrhage was more common in group B and indicates that the cystic wall after ethanol instillation is vulnerable to needle puncture or other irritation. On follow-up ultrasonography, all images of patients with intracystic hemorrhage revealed nearly complete disappearance of the cystic portion of the thyroid nodule. However intracystic hemorrhage during percutaneous ethanol injection results in improper reduction of cystic volume and can diminish the patient’s satisfaction with disappearance of the previous palpable thyroid mass in group B. Perithyroidal or pericapsular ethanol leakage during the procedure was observed in 2 patients (group A, n = 1; group B, n = 1). These cases showed progressive disappearance of the perithyroidal abnormality on follow-up ultrasonography and no significant thyroid hormonal alteration on follow-up thyroid function testing. Severe complications, such as vocal cord paralysis or secondary infection, were not observed in our study.

The group B patients’ complaint regarding the double puncture was significant. If a group B patient complained of severe anxiety regarding the needle puncture, local anesthetic was considered. However, percutaneous ethanol injection without aspiration of infused ethanol (group A) demanded one puncture, and local anesthetic was not used, although even one puncture was painful. In addition, percutaneous ethanol injection without aspiration of ethanol-mixed fluid (group A) was much more useful in patients with 2 or more cystic thyroid nodules.

The total procedure time was twice as long in group B as in group A because of the additional procedures, such as complete evacuation of the ethanol-mixed fluid and the 10-minute compression. This result is important to the physician as well as the patient because of its potential advantages, such as shortening of the total procedure time and decreasing the patient’s anxiety regarding the hospital stay.

A limitation of our study was the insufficient long-term follow-up more than 24 months after percutaneous ethanol injection to evaluate the cyst recurrence."