There are not many therapy alternatives to surgery if you have a goiter. The large goiter may be causing obstructive symptoms, or harbor a cancer.
The obstructive component can be evaluated by MR, and pulmonary function testing, including flow loop to see if there is any upper airway obstruction. Any suspicious nodules found on ultrasound need to be biopsied. If no obstruction or cancer is found, then alternatives are available. The most widely used is low dose Radio-iodine therapy.
In Europe and special centers, Laser has been used to shrink goiters. However, experience with this method is limited at present, although it seems promising.
Thyroid hormone is effective if the goiter responds to suppression.However, it usually dose not work on very large goiters. Ethanol Injections, PEI, are not for treatment of a whole gland, but for single cystic nodules. The best method now is Radio-iodine therapy.
Case Presentation:
69 Y/O female with coronary artery disease, bypass surgery, and mild heart failure was noted to have a large goiter causing tracheal deviation, and symptoms of obstruction. The MR showed mild tracheal narrowing, and the breathing test showed an abnormal flow loop consistent with upper airway obstruction due to the enlarged goiter. The treatment of choice is surgery, but because of her heart condition, alternatives were sought. Thyroid hormone was considered dangerous with heart disease. She was referred to me for consideration for ethanol, laser, or Radio-iodine. As listed above RAI was the best alternative for her. The goiter was visible from across the room.The trachea was deviated, and the ultrasound found two suspicious nodules in the goiter.They were biopsied and were benign colloid nodules. Thyroid blood testing was normal for TSH, T4, and Antibodies. The thyroid uptake was not elevated, but was to the lower normal range of 11% at 24 hours. Normal 8-32. After informed consent, including all about off label use of Thyrogen, rhTSH stimulation to boost the low uptake, she was put on a low iodine diet for two weeks. The single injection of rhTSH was given, and the TSH rose to 32. A repeat Thyrogen Stimulated thyroid uptake was positive for a significant increase in uptake to 56%. The image showed diffuse increased uptake throughout the goiter. The radiation safety instructions were reviewed with the patient and her urinary continence was assessed. There were no children in her house and she was told to stay away from her grandchildren. The arrival of the iodine dose was followed by confirming the correct dose was sent, checking for leaks, and preparing a paper for her to keep with her when she traveled by air to see her brother in 3 weeks. This will explain to the security at the airport that see has been treated with radiation, and is not a terrorist! The 30 Millicuries was given in my office as an outpatient and she was sent home. She was told to suck on lemon drops, and drink water, and avoid close contact with people for 5 days. She could go for her morning walks as usual. She could watch TV with her husband if she sat 3-5 feet away from him. She returned in one week and her thyroid goiter was firmer, but not tender.Thyroid blood tests revealed slight decrease in TSH, but no change in T4, or T3. By 12 weeks there was an obvious decrease in goiter size. Thyroid tests returned to normal, and the goiter had continued to decrease at 6 months. Repeat MR confirmed shrinkage, and the Flow loop study improved. The trachea was not narrowed, and the mild obstructive pattern on the flow loop was also better. She has noted improvement in her symptoms as well. She is followed twice yearly, and is doing well without ever having thyroid surgery.
When Surgery is offered as a treat option for your goiter, consider looking into alternative therapy with radio-iodine.
Good Luck,
Dr.G.
Tuesday, May 27, 2008
Sunday, May 25, 2008
88 Year Old with Recurrent Papillary Thyroid Cancer: Do No Harm or Treat?
Case Presentation:
Question:
Why are they treating 85-94 year old patients so aggressively?
Answer:
Because they have the tools to do it.
88 Y/O male with a 4 cm mass, which was proven to be a follicular variant of papillary cancer. After total thyroidectomy, he was subjected to hormone withdrawal at his age. Well it is no surprise that he was developed cardiac complications. The TSH >100, and TG was 88. He was stabilized, and cardiac failure treated, and was given 150 MCI I/131. The expected survival of 88 year old male is 4-5 years. After therapy the Neck ultrasound and TG, cancer marker were negative. Even with cardiac disease the oncologist pushed thyroid to suppress TSH. Also they did a Thyrogen stimulated TG, which was elevated to 15 from 3.7. He was given another 150MCI radioiodine, but alas the post therapy scan was negative. He developed side effects of the radiation. Dry mouth, hypotension, throat pain, nose bleed. He developed pseudogout, and more admissions followed. More studies were done including a PET/CT. A 7 mm nodule in the lung was seen. Symptoms of excess thyroid continued to occur do to suppressed TSH. More problems, this time a fracture again put him in the hospital. The rising TG was now 500. A PET positive mass in the lung and chest wall was found. The TG was now 1500. External beam radiation was given to the chest wall, even though there was no chest wall pain. The radiation caused more symptoms. TG went from 420 post EBRT to 1200. He lived for 8 years, but most of the time he was not well. We need to think about what we do to elderly patients with a tumor that slow growing and stop treating the TG numbers. As one smart thyroidologist once said at a meeting, "You never die from an elevated thyroglobulin. This patient was treated with external beam radiation at age 94! Now the oncologist was bragging about the fact he did not die of the cancer, but what about all the morbitity inflicted on the poor elderly gentleman, when the cancer was progressing in the expected slow course. The idea should be to do no harm, and only treat symptomatic lesions, or ones that could cause airway blockage or bleeding in the neck.
The second dose of I/131 was not helpful. The side effects were debilitating. Did the oncologist ever suffer cotton mouth symptoms, which this second dose I/131 of unlikely value, caused? The external beam to the chest wall did not relieve any chest wall pain as there was no pain. The oncologist was over eager to do something, when the best thing to do was to be conservative with a chronically ill octigenerian. Only 1600 thyroid cancer patients ever die from the disease in any year, but too many suffer early and late complications due to over-eager physicians chasing the thyroglobulin, with I/131, EBRT, PET/CT Scans, and morbitity inducing thyroid hormone withdrawal. He was too old to get cancers from the 300 millicuries given, but many younger patients are given 150 routinely after low risk thyroid cancer. They will by at risk for other cancers years later. There is a new generation of endocrine-oncologists that have available to them the most advanced methods to treat high risk thyroid cancers, but need to think twice before doing this to many 95 year olds.
Good Luck,
Dr.G.
Question:
Why are they treating 85-94 year old patients so aggressively?
Answer:
Because they have the tools to do it.
88 Y/O male with a 4 cm mass, which was proven to be a follicular variant of papillary cancer. After total thyroidectomy, he was subjected to hormone withdrawal at his age. Well it is no surprise that he was developed cardiac complications. The TSH >100, and TG was 88. He was stabilized, and cardiac failure treated, and was given 150 MCI I/131. The expected survival of 88 year old male is 4-5 years. After therapy the Neck ultrasound and TG, cancer marker were negative. Even with cardiac disease the oncologist pushed thyroid to suppress TSH. Also they did a Thyrogen stimulated TG, which was elevated to 15 from 3.7. He was given another 150MCI radioiodine, but alas the post therapy scan was negative. He developed side effects of the radiation. Dry mouth, hypotension, throat pain, nose bleed. He developed pseudogout, and more admissions followed. More studies were done including a PET/CT. A 7 mm nodule in the lung was seen. Symptoms of excess thyroid continued to occur do to suppressed TSH. More problems, this time a fracture again put him in the hospital. The rising TG was now 500. A PET positive mass in the lung and chest wall was found. The TG was now 1500. External beam radiation was given to the chest wall, even though there was no chest wall pain. The radiation caused more symptoms. TG went from 420 post EBRT to 1200. He lived for 8 years, but most of the time he was not well. We need to think about what we do to elderly patients with a tumor that slow growing and stop treating the TG numbers. As one smart thyroidologist once said at a meeting, "You never die from an elevated thyroglobulin. This patient was treated with external beam radiation at age 94! Now the oncologist was bragging about the fact he did not die of the cancer, but what about all the morbitity inflicted on the poor elderly gentleman, when the cancer was progressing in the expected slow course. The idea should be to do no harm, and only treat symptomatic lesions, or ones that could cause airway blockage or bleeding in the neck.
The second dose of I/131 was not helpful. The side effects were debilitating. Did the oncologist ever suffer cotton mouth symptoms, which this second dose I/131 of unlikely value, caused? The external beam to the chest wall did not relieve any chest wall pain as there was no pain. The oncologist was over eager to do something, when the best thing to do was to be conservative with a chronically ill octigenerian. Only 1600 thyroid cancer patients ever die from the disease in any year, but too many suffer early and late complications due to over-eager physicians chasing the thyroglobulin, with I/131, EBRT, PET/CT Scans, and morbitity inducing thyroid hormone withdrawal. He was too old to get cancers from the 300 millicuries given, but many younger patients are given 150 routinely after low risk thyroid cancer. They will by at risk for other cancers years later. There is a new generation of endocrine-oncologists that have available to them the most advanced methods to treat high risk thyroid cancers, but need to think twice before doing this to many 95 year olds.
Good Luck,
Dr.G.
Saturday, May 24, 2008
What Should You do if your Primary Care, or Endocrinologist tell You that Your Blood Calcium is Elevated and you need Surgery to Remove a Parathyroid
The most common cause is over-active parathyroid gland activity. Usually a single non cancerous tumor called a parathyroid adenoma. The screening testing is easy. Calcium, parathyroid hormone, and urine studies for calcium and creatine. But once the diagnosis is made the next step is not as easy. The location of the tumor can be anywhere in the neck, and may even be in the chest. Also, there may be co-existent thyroid tumors as well. The standard approach is to do a Parathyroid scan.They are hard to read and will negative even when the tumor is present. Do not go to surgery, without a high frequency parathyroid ultrasound. The experience of the parathyroid ultrasonographer is crucial to the success in finding the tumor. They can be found behind the esophagus, down in the thymic ligament and even in the thyroid. Incidental tumor nodules in the thyroid can be treated at the same time if positive for cancer. The parathyroid adenoma has a distinct look on US. It will be hypoechoic and have many shapes as it is soft. There will be a distinctive polar artery coming to the tumor. The parathyroid ultrasonographer will be able to biopsy the tumor with extremely small needles, and usually needs only one or two passes into the tumor. The chances for fibrosis are rare to none. The sample will be sent for cytology, and the needle washing for PTH. The cytology is not diagnostic, as it looks similar to a thyroid adenoma, but the PTH washing will be very elevated in most cases. With the knowledge that there is only one tumor, and the thyroid is not harboring a cancer nodule, the surgeon can do a quick 15 minute operation to remove the single adenoma. If the thyroid ultrasonographer finds more than one adenoma, or a mass is found in the thyroid, then the usual parathyroid exploration and thyroid removal would be needed. Also, if you have a recurrence after the first surgery, you need to see a expert parathyroid ultrasonographer, to find the abnormal gland. There can be a second adenoma missed on the first surgery, or it can be down in the chest. A CT of the Chest can help find that rare variation.
An endocrine neck lab such as mine, or a referral to a clinical thyroidologist with expert ultrasound experience in handling parathyroid localization procedures and biopsies can help your endocrinologist find your tumor.
Do it right the first time, and avoid an unnecessary long exploratatory surgery, or at least know that it is necessary because you had multiple parathyroid masses, or had a tumor nodule in the thyroid as well.
Case Presentation:
46Y/O Female with high Calcium and Blood PTH has parathyroid disease.
A second opinion was requested by her endocrinologist to help locate the adenoma.
Prior para thyroid scan was negative. Neck High frequency ultrasound was negative for locating it until I put 2 pillows under her back and with her neck hyperextended, I was able to see the right upper parathyroid which had been displaced to the area behind the esophagus. The thyroid gland was also abnormal. A 1.6 cm nodule was located in the right lobe.It had abnormal ultrasound changes suggestive of cancer. The biopsy of the parathyroid was done first. a washing for PTH was 56,000, and the cytology was consistent but not diagnostic,resembling a follicular neoplasm.The biopsy for the thyroid nodule was positive for papillary thyroid cancer. Prior to surgery, a lymph node mapping was done to see if neck nodes were invaded by thyroid cancer. The neck node ultrasound mapping was negative. The surgeon was told that because of the thyroid cancer the minimal surgery was not indicated, and a total thyroidectomy and central compartment node removal had to be done. The single adenoma was easily located behind the esophagus and the patient continues to have normal calcium 6 months after surgery.
We call that a "TWOfer". Two diseases with one surgery!
Good Luck,
Dr.G.
Endocrine Neck Lab of Southern California
Dr.G. is the thyroid and parathyroid ultrasonographer
www.endocrineneck.com
An endocrine neck lab such as mine, or a referral to a clinical thyroidologist with expert ultrasound experience in handling parathyroid localization procedures and biopsies can help your endocrinologist find your tumor.
Do it right the first time, and avoid an unnecessary long exploratatory surgery, or at least know that it is necessary because you had multiple parathyroid masses, or had a tumor nodule in the thyroid as well.
Case Presentation:
46Y/O Female with high Calcium and Blood PTH has parathyroid disease.
A second opinion was requested by her endocrinologist to help locate the adenoma.
Prior para thyroid scan was negative. Neck High frequency ultrasound was negative for locating it until I put 2 pillows under her back and with her neck hyperextended, I was able to see the right upper parathyroid which had been displaced to the area behind the esophagus. The thyroid gland was also abnormal. A 1.6 cm nodule was located in the right lobe.It had abnormal ultrasound changes suggestive of cancer. The biopsy of the parathyroid was done first. a washing for PTH was 56,000, and the cytology was consistent but not diagnostic,resembling a follicular neoplasm.The biopsy for the thyroid nodule was positive for papillary thyroid cancer. Prior to surgery, a lymph node mapping was done to see if neck nodes were invaded by thyroid cancer. The neck node ultrasound mapping was negative. The surgeon was told that because of the thyroid cancer the minimal surgery was not indicated, and a total thyroidectomy and central compartment node removal had to be done. The single adenoma was easily located behind the esophagus and the patient continues to have normal calcium 6 months after surgery.
We call that a "TWOfer". Two diseases with one surgery!
Good Luck,
Dr.G.
Endocrine Neck Lab of Southern California
Dr.G. is the thyroid and parathyroid ultrasonographer
www.endocrineneck.com
What is Thyroid Cancer Ultrasound Lymph Node Mapping, and why do I need to have one BEFORE my Cancer Surgery?
Prior to the new approach to thyroid cancer, the radio-iodine whole body scan WBS, was the mainstay of diagnostic cancer studies. Along came highly sensitive cancer markers, Thyroglobulin TG, and the TG antibody. The WBS was poor at detecting recurrence. The addition of the newer high frequency ultrasound was better at finding recurrences, than the WBS. With Cancer markers and Ultrasound we can find the cancer that is missed with WBS, and even after a post treatment scan. The lymph node mapping by high frequency ultrasound can find tumor recurrence even when the WBS, TG and PET/CT are negative! Well if it is that good after the surgery, maybe it is good PRIOR to the original surgery. In fact if you have a qualified clinical thyroidologist, and thyroid ultrasonographer map your neck BEFORE the original surgery, it will expand the scope of the first surgery in 20-30% of the patients with a positive needle biopsy confirming cancer or is suspicious of thyroid cancer. The expanded surgery would include the lateral neck nodes on the side of the positive node biopsy. Modern thyroid cancer pre-op should include a lymph node mapping. INSIST on one before the surgery.It will save you another surgery in 1-5 years. The first surgery is the most important. Recurrences will be less likely if positive nodes, which would be still left in the neck were not removed at the original surgery. The use of MR,CT or PET/CT will not be as accurate as Ultrasound in the right operators hands at finding your neck node disease. Ask your endocrinologist or internist to refer you to an endocrine neck ultrasound lab where a clinical thyroidologist, and ultrasonographer can help him. My referral endocrine neck ultrasound lab website is www.endocrineneck.com.
Case Presentation:
56 Y/O female was seen 6 weeks after total thyroidectomy for a needle biopsy proven papillary thyroid cancer. The internist sent her for management of the cancer, after the surgery. The cancer marker on Thyroid hormone was <0.1, and the TSH was 0.09. However the lymph node mapping found cancer nodes in the right neck. The ultrasound guided FNA biopsy was negative for cytology, but was positive for TG in the washings from the largest node. It is common that the cytology will miss the tumor , but the TG will be found in the node. Any TG in the node is abnormal.The patient was shocked that a node study was not done before the first surgery. I told her it was relatively new information,and not well known by non-specialists. The patient was sent back to surgery to do a modified neck dissection. 4/15 nodes were positive for metastatic thyroid cancer in the neck.
The best time to send a patient to the clinical thyroidologist is when the nodule is first found, not after the biopsy, and surely not after the crucial first surgery.
Good Luck,
Dr.G.
Case Presentation:
56 Y/O female was seen 6 weeks after total thyroidectomy for a needle biopsy proven papillary thyroid cancer. The internist sent her for management of the cancer, after the surgery. The cancer marker on Thyroid hormone was <0.1, and the TSH was 0.09. However the lymph node mapping found cancer nodes in the right neck. The ultrasound guided FNA biopsy was negative for cytology, but was positive for TG in the washings from the largest node. It is common that the cytology will miss the tumor , but the TG will be found in the node. Any TG in the node is abnormal.The patient was shocked that a node study was not done before the first surgery. I told her it was relatively new information,and not well known by non-specialists. The patient was sent back to surgery to do a modified neck dissection. 4/15 nodes were positive for metastatic thyroid cancer in the neck.
The best time to send a patient to the clinical thyroidologist is when the nodule is first found, not after the biopsy, and surely not after the crucial first surgery.
Good Luck,
Dr.G.
Thursday, May 22, 2008
What is Methylene Blue Dye Localization, and why do I need to know about it if I have recurrent thyroid cancer after multiple surgeries?
Case Presentation:
69 Y/O female with an aggressive form of papillary thyroid cancer called Tall Cell Variant. She has had total thyroidectomy, and central compartment node removal.. 150 MCI was given after the first surgery. The first recurrence was in the right lateral neck. Another surgery was done. 200 Millicuries of I/131 was given. Over 12 months her
thyroglobulin,TG rose from 0.36 to 6.5 with suppressed TSH. The last Whole body scan was negative. The ultrasound lymph node mapping revealed central compartment abnormal nodes. The USGFNA biopsy was positive for recurrence, and the TG Cancer marker was 35,000 in the needle washing from the largest node. Because of the aggressive nature of the cancer a PET/CT was done to make sure there was distant spread to the lungs or bones. The scan was positive only for the nodes seen on ultrasound in the central compartment. The patient had suffered a right vocal cord injury at the first surgery, and therefore re-entry in the central compartment was more risky. The thyroid surgeon agreed to go in only if I could localize the nodes for him before the surgery. One hour before she went to the hospital, she came to the thyroid center, and under US guidance I placed a drop of dye on the anterior surface of the largest node. The surgery was uneventful. There was no changes in her voice or the blood calcium post surgery. However when she returned for the 4 week post surgery visit her cancer marker was markedly decreased from 6.5 to just above the lower limit of <0.15, at 0.23. There were 3 positive nodes clustered around the blue dye marked node. The surgeon had no problem finding the PET positive nodes with my dye marker.
Thyroid cancer, Tall Cell Variant, thyroid ultrasound lymph node marking, Thyroid ultrasound Guided lymph node FNA biopsy, Thyroglobulin washing for the cancer node, Methylene blue dye cancer lymph node localization procedure prior to surgery.
Good Luck,
Dr.G
69 Y/O female with an aggressive form of papillary thyroid cancer called Tall Cell Variant. She has had total thyroidectomy, and central compartment node removal.. 150 MCI was given after the first surgery. The first recurrence was in the right lateral neck. Another surgery was done. 200 Millicuries of I/131 was given. Over 12 months her
thyroglobulin,TG rose from 0.36 to 6.5 with suppressed TSH. The last Whole body scan was negative. The ultrasound lymph node mapping revealed central compartment abnormal nodes. The USGFNA biopsy was positive for recurrence, and the TG Cancer marker was 35,000 in the needle washing from the largest node. Because of the aggressive nature of the cancer a PET/CT was done to make sure there was distant spread to the lungs or bones. The scan was positive only for the nodes seen on ultrasound in the central compartment. The patient had suffered a right vocal cord injury at the first surgery, and therefore re-entry in the central compartment was more risky. The thyroid surgeon agreed to go in only if I could localize the nodes for him before the surgery. One hour before she went to the hospital, she came to the thyroid center, and under US guidance I placed a drop of dye on the anterior surface of the largest node. The surgery was uneventful. There was no changes in her voice or the blood calcium post surgery. However when she returned for the 4 week post surgery visit her cancer marker was markedly decreased from 6.5 to just above the lower limit of <0.15, at 0.23. There were 3 positive nodes clustered around the blue dye marked node. The surgeon had no problem finding the PET positive nodes with my dye marker.
Thyroid cancer, Tall Cell Variant, thyroid ultrasound lymph node marking, Thyroid ultrasound Guided lymph node FNA biopsy, Thyroglobulin washing for the cancer node, Methylene blue dye cancer lymph node localization procedure prior to surgery.
Good Luck,
Dr.G
Wednesday, May 21, 2008
PEI: What is Percutaneous Ethanol Injection, and why do I need to know about it, if I have had multiple surgeries for papillary thyroid cancer?
Case Presentation:
70 Y/O Japanese female with multiple surgeries in the lateral neck after total thyroidectomy for papillary thyroid cancer. Her cancer marker rose again, and she was given another thyroid cancer lymph node mapping. There was a 7 mm tall and 6 mm wide node in level 4 on the right side. The node had abnormal Doppler blood flow suggestive of another recurrence. She was given an USG FNA of the node, and cancer marker was collected from the needle washings. The cytology was negative, but the cancer marker in the washings from the lymph node was 156,000. This was diagnostic of metastatic papillary thyroid cancer. She was told it was too risky to operate again due to scarring and high complication rate. The surgeon recommended she have radio-iodine instead. Her endocrinologist had heard about alternatives to surgery, and knew radio-iodine was not helpful to kill lymph nodes. He referred her to me for evaluation for PEI. I called the surgeon and suggested he might want to do the surgery, if I could mark the cancerous node , by placing a small dot of blue dye on the abnormal node one hour before surgery to reduce the risk of complications. He refused my request. I was left with PEI as the only other treatment. I injected ethanol directly into the cancerous node under ultrasound guidance. She had no complications, but did note a slight tingling along the tract of the needle when I pulled it out. The return visit in 4 weeks was notable for a complete loss of blood flow by Doppler, and a 67% reduction of the node. Also the cancer marker dropped 3 fold to <0.1. 2 more sessions resulted in a small remnant node with no blood flow. The yearly ultrasound follow exams have shown no recurrence of the node in question, and the cancer marker is still non-detectable.
PEI is a new method for treatment of recurrent thyroid cancer in the neck. It is operator dependent and should only be done by expert thyroid interventional ultrasonographers.
Good Luck,
Dr.G.
70 Y/O Japanese female with multiple surgeries in the lateral neck after total thyroidectomy for papillary thyroid cancer. Her cancer marker rose again, and she was given another thyroid cancer lymph node mapping. There was a 7 mm tall and 6 mm wide node in level 4 on the right side. The node had abnormal Doppler blood flow suggestive of another recurrence. She was given an USG FNA of the node, and cancer marker was collected from the needle washings. The cytology was negative, but the cancer marker in the washings from the lymph node was 156,000. This was diagnostic of metastatic papillary thyroid cancer. She was told it was too risky to operate again due to scarring and high complication rate. The surgeon recommended she have radio-iodine instead. Her endocrinologist had heard about alternatives to surgery, and knew radio-iodine was not helpful to kill lymph nodes. He referred her to me for evaluation for PEI. I called the surgeon and suggested he might want to do the surgery, if I could mark the cancerous node , by placing a small dot of blue dye on the abnormal node one hour before surgery to reduce the risk of complications. He refused my request. I was left with PEI as the only other treatment. I injected ethanol directly into the cancerous node under ultrasound guidance. She had no complications, but did note a slight tingling along the tract of the needle when I pulled it out. The return visit in 4 weeks was notable for a complete loss of blood flow by Doppler, and a 67% reduction of the node. Also the cancer marker dropped 3 fold to <0.1. 2 more sessions resulted in a small remnant node with no blood flow. The yearly ultrasound follow exams have shown no recurrence of the node in question, and the cancer marker is still non-detectable.
PEI is a new method for treatment of recurrent thyroid cancer in the neck. It is operator dependent and should only be done by expert thyroid interventional ultrasonographers.
Good Luck,
Dr.G.
PEI: What is PEI and why do I need to know about it, if I have a thyroid cyst, or parathyroid cyst, and have been told to have surgery?
Case Presentation:
50 Y/O Chinese male was told in Shanghai, that the only therapy for his recurrent thyroid cyst was surgery. A modern Chinese male hits the web to research this, before submitting for surgery. He found thyroid,com, and emailed me about coming to the USA for a consultation. He was euthyroid, on no medications, and had a 15 cc pure cyst.
The ultrasound guided FNA biopsy confirmed the cyst was indeed thyroid in nature, and the biopsy was negative for cancer. When he next visited the USA, under US guidance I
withdrew 15 cc of cyst fluid and re-injected 7.5 cc of medical grade ethanol. There was no pain or complications. He returned to see me 6 weeks later. The cyst was not visible anymore, and the ultrasound confirmed it was >99% ablated. There was a 1-2 mm residual seen on ultrasound.He had his wish come true to fix the cyst, but without major surgery, and hospitalization.
This PEI procedure can be used as primary treatment for non-functioning parathyroid cysts, and thyroglossal ducts that have recurred and failed surgery. It is mandatory to rule out cancer in mixed cysts of any nature before PEI is considered as a therapy option. It has another major use in the treatment of recurrent cancer lymph nodes in thyroid cancer patients,after a recurrence and prior neck explorations.
Good Luck,
Dr.G.
50 Y/O Chinese male was told in Shanghai, that the only therapy for his recurrent thyroid cyst was surgery. A modern Chinese male hits the web to research this, before submitting for surgery. He found thyroid,com, and emailed me about coming to the USA for a consultation. He was euthyroid, on no medications, and had a 15 cc pure cyst.
The ultrasound guided FNA biopsy confirmed the cyst was indeed thyroid in nature, and the biopsy was negative for cancer. When he next visited the USA, under US guidance I
withdrew 15 cc of cyst fluid and re-injected 7.5 cc of medical grade ethanol. There was no pain or complications. He returned to see me 6 weeks later. The cyst was not visible anymore, and the ultrasound confirmed it was >99% ablated. There was a 1-2 mm residual seen on ultrasound.He had his wish come true to fix the cyst, but without major surgery, and hospitalization.
This PEI procedure can be used as primary treatment for non-functioning parathyroid cysts, and thyroglossal ducts that have recurred and failed surgery. It is mandatory to rule out cancer in mixed cysts of any nature before PEI is considered as a therapy option. It has another major use in the treatment of recurrent cancer lymph nodes in thyroid cancer patients,after a recurrence and prior neck explorations.
Good Luck,
Dr.G.
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