This protocol covers the clinical situation of a pure or predominantly cystic benign thyroid nodule causing local compression symptoms, where the nodule has relapsed after first-line ethanol ablation (EA) — and a next management step is required.
Ethanol ablation is an effective, safe, and cost-effective first-line approach for cystic or predominantly cystic symptomatic thyroid nodules. In a subset of patients, the nodule re-expands after EA and local compression symptoms return, defining the point of treatment failure that prompts escalation.
First-line treatment with ethanol ablation (EA) — injection of ethanol into the cystic cavity — did not sustain its targets: a long-lasting decrease in nodule volume (57–77% at 5 years) with meaningful improvement of local symptoms. Nodule relapse after EA is the defined trigger for escalation to this next-line protocol.
Following relapse after EA, current evidence supports a thermal-based ablation technique directed at the cystic lesion. The specific modality, patient eligibility criteria, and procedural approach are detailed in the complete structured protocol available below.
The aim of next-line treatment is a long-lasting reduction in nodule volume (57–77% at 5 years) with sustained relief of local compression symptoms and improvement in disease-related quality of life.
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 while TA procedures, due to their geometric and predictable volume of tissue destruction, are the first-line treatment for solid thyroid lesions.
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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