| Treatment type . | Advantages . | Disadvantages . |
|---|---|---|
Surgery | Nodule ablation, complete relief of symptoms, definite histological diagnosis | Inpatient, high cost, risks associated with surgery, vocal cord paralysis (approximately 1% of patients), hypoparathyroidism (<1%), hypothyroidism (1% in case of lobectomy) |
l-thyroxine | Outpatient, low cost, may slow nodule growth, may prevent new nodule formation | Low efficacy, need for lifelong treatment, regrowth after cessation of treatment, cardiac tachyarrhythmias, reduced bone density, not feasible when thyrotropin level is suppressed |
Radio-iodinea | Outpatient, low cost, high success rate (normalization of thyrotropin in >95% and nodule reduced by 40% in 1 year) | Hypothyroidism (10% in 5 years), risk of radiation thyroiditis and thyrotoxicosis, only gradual reduction of the nodule, use of contraceptives in fertile women |
Ethanol injection | Outpatient, relatively low cost, no hypothyroidism, nodule reduced by >40% in 6 months | Limited experience with treatment, decreasing efficacy with increasing nodule size, operator dependency, painful (reducing compliance), risk of thyrotoxicosis and vocal cord paralysis (1–2%), seepage of ethanolb, cytological/histological interpretation impeded in treated nodules, repeat injections often needed |
Laser treatmentc | Outpatient, relatively low cost, no hypothyroidism, nodule reduced by >40% in 6 months | Limited experience with treatment, operator dependency, cytological/histological interpretation impeded in treated nodules |
| Treatment type . | Advantages . | Disadvantages . |
|---|---|---|
Surgery | Nodule ablation, complete relief of symptoms, definite histological diagnosis | Inpatient, high cost, risks associated with surgery, vocal cord paralysis (approximately 1% of patients), hypoparathyroidism (<1%), hypothyroidism (1% in case of lobectomy) |
l-thyroxine | Outpatient, low cost, may slow nodule growth, may prevent new nodule formation | Low efficacy, need for lifelong treatment, regrowth after cessation of treatment, cardiac tachyarrhythmias, reduced bone density, not feasible when thyrotropin level is suppressed |
Radio-iodinea | Outpatient, low cost, high success rate (normalization of thyrotropin in >95% and nodule reduced by 40% in 1 year) | Hypothyroidism (10% in 5 years), risk of radiation thyroiditis and thyrotoxicosis, only gradual reduction of the nodule, use of contraceptives in fertile women |
Ethanol injection | Outpatient, relatively low cost, no hypothyroidism, nodule reduced by >40% in 6 months | Limited experience with treatment, decreasing efficacy with increasing nodule size, operator dependency, painful (reducing compliance), risk of thyrotoxicosis and vocal cord paralysis (1–2%), seepage of ethanolb, cytological/histological interpretation impeded in treated nodules, repeat injections often needed |
Laser treatmentc | Outpatient, relatively low cost, no hypothyroidism, nodule reduced by >40% in 6 months | Limited experience with treatment, operator dependency, cytological/histological interpretation impeded in treated nodules |
Treatment of the autonomous thyroid nodule.
Side effects due to ethanol escaping outside the nodule or drainage of ethanol are rare (<1%) and comprise nerve damage, perinodular/periglandular fibrosis jeopardizing subsequent surgery, thrombosis of the jugular vein, and neck haematomas.
Laser treatment is still experimental. The advantages are similar to those of ethanol injection, but side effects are fewer due to the higher degree of control with laser therapy which limits the risk of extranodular damage.
This PDF is available to Subscribers Only
View Article Abstract & Purchase OptionsFor full access to this pdf, sign in to an existing account, or purchase an annual subscription.
