Horner Syndrome After Percutaneous Ethanol Injection For Treatment Of Metastatic Papillary Thyroid Carcinoma: Case Report And Review Of The Literature

Abstract

ABSTRACT: Objective: One option to treat locoregional recurrence of thyroid carcinoma is with percutaneous ethanol injection (PEI). Although complications with this treatment are rare, we describe a patient who developed Horner syndrome after PEI. In addition, we reviewed the literature on complications after PEI for thyroid disease.Methods: A clinical case report was performed on a patient who underwent PEI and subsequently developed ptosis, miosis, and anhidrosis. Based on these classic findings, she was diagnosed with Horner syndrome. A Medline search was performed to identify all complications after PEI for thyroid disease.Results: A 31-year-old woman with stage 1 papillary thyroid carcinoma (PTC) metastatic to the cervical lymph nodes was treated by total thyroidectomy and central lymph node dissection followed by radioactive iodine. The disease recurred in a single lymph node in the right neck, and she opted for PEI treatment. Postprocedurally, the patient developed right-sided miosis, ptosis, and anhidrosis. Symptoms were consistent with Horner syndrome. She was treated with a steroid burst and taper. After 6 months, her symptoms improved but had not fully resolved.Conclusion: PTC can be treated in multiple ways. To avoid re-operation in patients with recurrent PTC that is limited to a few lymph nodes, PEI can be a useful treatment option. Ethanol injection into live tissue causes dehydrative effects and can damage nearby structures. However, the literature demonstrates that serious complications after PEI are rare. Nonetheless, these rare complications are important to acknowledge in order to better counsel patients prior to treatment.Abbreviations: PEI = percutaneous ethanol injection; PTC = papillary thyroid carcinoma