I want to know if thyroid med. Will help in shrinking this large cyst I have on my thyroid. I have been to surgeon. And he is recommending me see endocrinologist to see if meds will help or if surgery is recommended. Going March 20th. I am having many aweful symptoms. Trouble breathing some, feels like food gets stuck in my throat, sore throat. I have had all the necessary tests done-uptake(showed little hyper), blood work(normal), ultrasound (showed mass),swallow test (normal). I am just getting impatient and really want to know if I have to have surgery or not..what do u think???
Wow - a cut/paste from a Laszlo Hegedus publication - I just spoke via e-mail with him last week about these types of things.
Ethanol injection can be done -- there are only a few people doing it and the cyst has to have certain characteristics. Dr. Guttler in Santa Monica can certainly evaluate it if you are in that area of the country.
The current standard of care is surgery if repeated attempts at drainage result in reaccumulation of the fluid. Medication is not likely to help.
Have not seen any good research on the herbal approach to this problem.
As I stated in one of my comments, the cyst can be aspirated.The thyroid clinic in Santa Monica, CA is using ethanol injection for cysts and nodules. The Green life company is advertizing natural herbal medicine that reducing the cysts and goiter size in Hyperthyroid patients.
Treatment of Recurrent Thyroid Cysts with Ethanol: A Randomized Double-Blind Controlled Trial
Finn Noe Bennedbæk and Laszlo Hegedüs
Department of Endocrinology, Odense University Hospital, DK-5000 Odense C, Denmark
We concluded that treatment of recurrent thyroid cysts with ethanol is superior to simple aspiration and flushing with saline and devoid of serious side effects. Our study demonstrates that flushing with ethanol is a clinically significant nonsurgical alternative for thyroid cysts that recur despite repeat aspirations.
At the last visit, patients were asked to rate their present pressure symptoms and cosmetic complaints as present or absent (dichotomous data).
The study was carried out with complete blinding of both investigators (F.N.B. and L.H.) and patients. The Pharmacy of Odense University Hospital (Centralapoteket OUH) was responsible for the production of absolute ethanol (800 mg/ml) and isotonic saline, for preparation of bottles labeled "project ethanol vs. saline," and for providing sealed code lists. A pharmacist independent of the investigators provided the investigators with 68 sealed boxes (labeled patient no. 1, 2, etc.). Each box contained three sealed bottles with 10 ml of sterile fluid (34 x 3 with saline and 34 x 3 with ethanol), and each was labeled "project medicine." The corresponding list with codes detailing the content of the bottles was stored in a sealed envelope at the pharmacy. Complete blinding was maintained throughout the whole study period, and the sealed envelope with treatment codes was not broken until the 6-month evaluation of the last patient. Allocation of treatment was thus carried out in an unbiased way.
Clinical data for the 66 consecutive patients are given in Table 1 . All patients were treated 4–12 wk after the last recurrence. The groups were similar regarding sex, age, nodule duration, and the number of recurrences after previous aspirations. Likewise, there were no statistical differences regarding the number of pure cysts, cysts with a minor solid component, and the presence of additional small nodules or volume estimates in the two treatment groups. Serum TSH values were similar; serum free T4 and free T3 indices were slightly lower in the saline group, but we consider this finding of no clinical significance.
The median treatment volume given was 3.5 ml [quartiles, 2;5] in the percutaneous ethanol injection (PEI) group compared with 3.0 ml [2;5] in the saline (NaCl) group corresponding to 36% of the cyst volume in each group (P = 0.4). Treatment response differs markedly based on the median number of treatments given: 1 [1;2] in the PEI group compared with 3 [2;3] in the saline group (P = 0.0002). A total of 27 patients (82%) treated with PEI were cured, 21 of whom (78%) were cured after only one treatment, compared with a total of 16 patients (48%) treated with saline, six of whom (38%) were cured after one treatment—a highly significant difference between the two treatment groups (P = 0.006). Failure, on the other hand, was seen in six (18%) in the PEI group compared with 17 (52%) in the saline group. A priori failure was defined as a cyst volume of more than 1 ml, and this was chosen on clinical grounds as a volume reduction from e.g. 20 to 8 ml; this may represent a statistically significant change but not necessarily a clinically relevant change that is satisfactory for the patient. The median reduction in cyst volume was 100% [83;100] in the PEI group, compared with 68% [21;94] in the saline group (P = 0.001). Results from the 3- and 6-month evaluations did not differ.
Gender does not influence outcome, but there is a nonsignificant trend toward female sex being advantageous. Likewise, there is a trend toward nodule duration and also the presence of additional nodules influencing the chance of success. Pretreatment cyst volume, however, does influence the chance of success, i.e. having smaller cysts being advantageous (P = 0.005), whereas total thyroid volume has only a borderline-significant effect on outcome (P = 0.05). Age and US findings (cystic vs. complex) do not influence outcome.
The presence or absence of pressure symptoms and/or cosmetic complaints at the end of follow-up correlated in all but one of the 66 patients to the a priori chosen cut-off limit of a cyst volume larger or smaller than 1 ml.
Seven patients (21%) in the ethanol group reported transient pain/tenderness, with a duration of 10 min or less in six patients and 1 h in one patient. Only one patient in the saline group reported pain lasting for 10 min after treatment. One patient in the PEI group had transient dysphonia lasting for 1 h, but all patients, including the latter, had a normal indirect laryngoscopy after treatment. Due to treatment failure, a hemithyroidectomy was subsequently performed in all six patients treated with PEI; in one of these patients, the surgeon described periglandular fibrosis making the surgical procedure more difficult but causing no complications. No further side effects were encountered, and thyroid function remained unaltered throughout the entire period of follow-up (data not given). Among the saline treatment failures (n = 17), all were offered surgery according to the protocol, but seven refused surgery and were offered follow-up with repeat aspiration or treatment with PEI. Ten patients were thus referred for surgery (hemithyroidectomy). The procedure was uncomplicated in all except for postoperative bleeding in one patient necessitating reoperation, but no periglandular fibrosis was described.
Our study shows that PEI sclerotherapy reduces recurrence rate of thyroid cysts relapsed after evacuation alone and that cure was obtained in 64% of patients after one treatment only and in 82% overall. This contrasts with the 48% who were cured after simple aspiration and flushing with saline, of whom only 18% were cured by one treatment. Although a definition of failure as a thyroid cyst volume of 1 ml seems rigorous, it is based on clinical grounds. In most published studies on PEI in thyroid cysts, a success rate is defined as near disappearance or marked (>50%) size reduction of the cystic lesion. In our experience, most cystic nodules vary in size, and although size reduction is often seen during follow-up of cysts primarily evacuated, they tend to increase gradually given enough time.
The technique used by us is flushing with absolute ethanol ( 99%) in an amount of 25–50% of the cyst volume (maximum 10 ml), preceded by a submaximal aspiration ( 90%) of the cyst fluid under US guidance. Ethanol is left in place for 2 min, and subsequently a complete aspiration is performed. As opposed to the technique described in the published studies on PEI in thyroid cysts, we recommend subsequent complete aspiration of ethanol. It is important to recognize that each ethanol injection carries a risk of ethanol escaping outside the capsule, inducing paraglandular fibrosis as described in patients with solid cold thyroid nodules treated with PEI (30). This was seen in one of six patients with relapse in the PEI group subjected to subsequent malignancy.
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