Ethanol ablation of thyroid cysts in the young with a focus on efficacy and quality of life

Abstract

Objective: Ultrasound-guided percutaneous ethanol injection therapy (US-PEIT) is used in patients with recurrent symptomatic thyroid cysts as a credible alternative to surgery. Young patients commonly do not wish to undergo surgery and prefer ethanol ablation, if available. The effect of this approach on quality of life is an essential factor in deciding on the treatment options, especially in the young with a long life expectancy and no comorbidity. Methods: We performed US-PEIT in a cohort of young patients, 15–30 years, from 2015 to 2020. The patients’ general quality of life (QoL), self-reported compression symptoms and neck appearance were evaluated. Results: The cohort comprised 59 patients with 63 cysts, more women than men, with a mean age of 23.8 years. About 1.5 mL of injected alcohol were needed to reach a 90.7% mean cyst volume reduction ratio in 12 months. The method did not fail in any of the patients; a single US-PEIT session was undertaken in 46% of them. The procedure significantly improved each of the patients’ symptoms with a significant total score difference (P < 0.001). The total symptom score correlated with the initial cyst volume (P = 0.002; r = 0.395). The mean QoL score by SF-36 6 months after the last US-PEIT was significantly different for physical component summary 56.5 (P < 0.001) but not different for mental component summary 47.7 (P = 0.125), compared to age-corresponding norms. Conclusions: US-PEIT is a safe and effective method for the young, leading to improvements in cosmetic and subjective complaints, and should also be considered as first-line treatment in the young.

Keywords

• thyroid cyst
• ultrasound-guided percutaneous ethanol injection therapy (us-peit)
• ethanol ablation (ea)
• volume reduction ratio
• quality of life (qol)