Who is suitable instead of surgery
The method was developed primarily for cystic thyroid nodules. A simple puncture with removal of fluid gives only a temporary effect: the cavity fills again, and after a few months the cyst returns to its previous size. The introduction of ethanol causes obliteration - the walls of the cavity stick together, and relapse becomes much less likely.
The procedure is performed on an outpatient basis under ultrasound guidance. First, the contents of the cyst are completely evacuated with a needle, then a small volume of sterile ethanol is injected into the cavity, which is removed after some time. Sometimes several sessions are required at intervals of several weeks. There may be a short-term burning sensation and pain in the neck area for several hours.
A prerequisite is proven good quality of the node. Before sclerotherapy, a fine-needle biopsy is performed, since it is unacceptable to inject ethanol into a formation of unknown nature: this will distort the subsequent morphological picture. The method is not used if malignancy is suspected, if the node is located retrosternally, or if there are severe signs of tracheal compression that require surgery. For dense solid nodes, the effectiveness is lower than for cystic ones.
Thyroid nodules: what is important to know
Thyroid nodules are very common and in the vast majority of cases are benign. The doctor’s task is to identify those few that require intervention, and not subject the rest to unnecessary procedures.
The selection is carried out according to ultrasound characteristics: shape, contours, echogenicity, the presence of microcalcifications and the nature of blood flow. Based on their totality, the node is assigned a TI-RADS category, which, together with its size, determines the indications for puncture.
The role of the recurrent laryngeal nerve
The recurrent laryngeal nerve runs directly along the posterior surface of the thyroid gland and controls the vocal cords. Its damage leads to hoarseness, and if bilateral, to respiratory failure.
That is why thyroid surgery is performed by a specialized surgeon, and the mobility of the vocal cords is assessed before and after the intervention. Modern techniques include visual identification of the nerve, and in some cases, intraoperative neuromonitoring.
Hormonal control after intervention
Removing part of the gland can lead to decreased hormone production. Therefore, 4–6 weeks after surgery, the TSH level is determined and, if necessary, the dose of levothyroxine is adjusted.
Blood calcium is separately controlled: next to the thyroid gland there are parathyroid glands that regulate calcium metabolism. Their temporary dysfunction after surgery is possible and is manifested by numbness and tingling in the fingers and around the mouth.