A 7-year follow-up of patients with thyroid cysts and pseudocysts treated with percutaneous ethanol injection: volume change and cost analysis

Thyroid cysts and pseudocysts, or hemorrhagic cysts, are quite frequent thyroid pathologies. Surgical theraphy has always been the treatment of choice in this pathology, but percutaneous ethanol injection (PEI) is becoming still more common. PEI was originally used in the treatment of liver nodules and subsequently in solid, hyperfunctioning thyroid nodules, but today it is used exclusively in cysts. The aim of this study was to evaluate the efficacy of PEI in reducing thyroid cyst volume 12 and 84 months after treatment and to compare cost-benefit to that of surgical treatment. The study includes 110 consecutive patients, who all underwent PEI after cytological analysis had excluded the presence of neoplasia. All patients had refused surgical treatment. One patient died during the follow-up due to cerebral hemorrhage. Each patient received an average of 5.3 ± 2.7 PEI treatments. After 12 months, volume was reduced by 82.6% and after 84 months by 93.03%. Dysphonia occurred in 2 cases of which one resolved spontaneously and one received cortisone therapy. The cost of PEI treatment is considerably lower than the cost of surgical therapy (the cost saving in our patient population was about €200,000). PEI should therefore be preferred to surgical treatment due to its efficacy and lower cost.