Multinodular Goiter with Cystic Thyroid Lesion: What to Do When Ethanol Ablation Has Not Achieved a Lasting Response
This protocol addresses a specific situation within multinodular goiter: a patient with a pure or predominantly cystic, benign, symptomatic thyroid lesion that has relapsed after ethanol ablation — the recommended first-line minimally invasive approach for this lesion type.
Clinical Scenario
The lesion is pure or predominantly cystic, confirmed benign, and causing local symptoms in the context of multinodular goiter. Ethanol ablation (EA), based on direct injection of ethanol into the cystic cavity, was selected as first-line treatment — it is considered an effective, safe, and inexpensive approach for this lesion type. However, the cystic lesion has relapsed and local symptoms persist.
Prior Treatment — Why This Protocol Applies
Previous treatment: Ethanol ablation (EA)
Goals not reached: Relevant and long-lasting decrease of nodule volume, with improvement of local symptoms.
Relapse after EA indicates that the first-line approach did not produce a durable result. This failure is the trigger for the structured next-line protocol described here.
Next-Line Approach
For cystic lesions that relapse after ethanol ablation, a thermal-based minimally invasive technique is the next intervention to consider. The clinical goal is a relevant and long-lasting decrease in nodule volume alongside improvement of local symptoms. The full protocol defines the criteria, sequencing, and application details for this approach.
References
DOI: 10.1530/ETJ-23-0067
Consider EA as the first-line treatment for pure, or dominantly cystic, thyroid lesions.
EA is preferred as an effective, safe, and inexpensive treatment for cystic (or predominantly cystic) symptomatic thyroid nodules.
Consider TA for the treatment of solid benign thyroid nodules that cause local symptoms as an alternative to surgery and for cystic lesions that relapse after EA.
MITs result in a relevant and long-lasting decrease of nodule volume (57–77% at 5 years) that is paralleled by improvement of local symptoms and disease-related quality of life.
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