Different retained dosage of lauromacrogol within the thyroid cyst in the sclerotherapy of thyroid cysts:an analysis of the curative effect / 介入放射学杂志

Objective To analyze the effect of different retained dosage of lauromacrogol within the thyroid cyst in the sclerotherapy of thyroid cysts.Methods A total of 200 patients with thyroid cysts,who were admitted to the Longyan Municipal First Hospital of China between August 2020 and August 2021,were enrolled in this study.The patients were randomly and equally divided into group zero(suctioning out all the amount of the injected lauromacrogol),and,according to the percentage of the retained lauromacrogol dosage to the total cystic fluid,group 10%,group 20%,group 30%and group 50%,with 40 patients in each group.Thyroid color ultrasound was reviewed at 1,3,6,and 12 months after treatment.The changes of capsule volume,curative efficacy,influencing factors,and adverse reactions after the cyst became sclerosis were analyzed.Logistic regression analysis was used to analyze the factors affecting the postoperative efficacy.Results In all the 5 groups,the suctioned fluid was dark red in colour,and the patients had cystic nodules.The preoperative mean cyst volume was(20.43±5.86)cm3.In all the 5 groups,the postoperative changes in cyst volume indicated that the postoperative one-month cyst volume significantly shrank when compared with the preoperative volume,the postoperative 3-month cyst volume remarkably shrank when compared with the postoperative one-month volume,and the postoperative 6-month cyst volume strikingly shrank when compared with the postoperative 3-month volume(all P＜0.05),while no statistically significant difference in the cyst volume existed between the postoperative 12-month value and the postoperative 6-month value(P＞0.05).The postoperative 6-month total effective rate of all the five groups was 87%(174/200),and no statistically significant differences in the postoperative 6-month curative effect existed between each other among the 5 groups(P＞0.05).Taking the postoperative 6-month curative effect as the dependent variable,and the age,sex,thick cystic wall,cystic septum,and preoperative cyst volume as independent variables,the binary logistic regression analysis was conducted,which revealed that the thick cystic wall(OR=0.24,95%CI=0.08-0.72,P=0.01)and the cystic septum(OR=0.21,95%CI=0.07-0.67,P=0.01)were the factors affecting the postoperative 6-month curative effect.The main side reaction was pain,which was tolerable by patients.There was no significant difference in the incidence of adverse reactions between each other among the five groups(all P＞0.05).Conclusion In treating thyroid cysts by using ultrasound-guided lauromacrogol sclerotherapy,there is no relationship between the curative effect and the percentage of the retained lauromacrogol dosage to the total cystic fluid.The best curative effect can be achieved at 6 months after injection of lauromacrogol,which can be used as the optimal time for follow-up check.The thick cystic wall and the cystic septum are the main factors that affect the curative effect of lauromacrogol sclerotherapy.For the treatment of thyroid cyst,lauromacrogol sclerotherapy carries reliable curative effect with few adverse reactions,therefore,this therapy is worthy of clinical application.(J Intervent Radiol,2024,32:69-73)

Cervical Bronchogenic Cyst Mimicking Thyroid Cyst

Bronchogenic cysts are rare congenital malformations that result from an abnormal development of the ventral foregut budding of the tracheobronchial tree at the time of organogenesis. They are usually located in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual, and specially, bronchogenic cysts presenting as thyroid and perithyroid cyst are quite rare. We report a case of bronchogenic cyst mimicking a thyroid colloid cyst. We tried percutaneous ethanol injection at 3 times for treatment of this thyroid cyst, but we failed, because of intractable cough. After cyst excision with thyroid lobectomy, we diagnosed the lesion to bronchogenic cyst. Bronchogenic cyst should be considered in the differential diagnosis of perithyroid cyst, which especially the lesion is intolerable cyst to enthanol injection.

Cystic Medullary Thyroid Carcinoma: A Case of Undergoing Endoscopic Thyroid Lobectomy / 대한내분비외과학회지

On ultrasonography, medullary thyroid carcinoma (MTC) shows hypoechogenicity, an irregular margin, a predominantly solid composition, and microcalcifications, similar to those observed in papillary thyroid carcinoma (PTC). MTC presenting as a cystic lesion is rare, and endoscopic thyroidectomy can be performed for benign thyroid masses and early stage PTC, however it is inappropriate for MTC regardless of cystic change. The authors report a case of cystic MTC found after endoscopic thyroid lobectomy and provide a review of the literature on this topic.

The Utility of Sono-Guided Sclerotherapy for Benign Thyroid Cyst: Prospective Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ultrasonography (USG)-guided sclerotherapy using a sclerotherapic agent such as ethanol, OK-432, recently has gained popularity as a treatment for nonfunctioning benign thyroid nodules. The study evaluates the efficacy and safety of the USG-guided sclerotherapy for that purpose. SUBJECTS AND METHOD: Included in the study were 23 patients who had complaints of applied pressure or cosmetic problems due to cystic thyroid nodules, which had been diagnosed as benign and nonfunctioning by fine-needle aspiration biopsy and thyroid function test. Sclerotherapy was performed with OK-432 or 99.9% ethanol following nearly complete evacuation of the fluid from the cystic portion of thyroid nodule. At each USG follow-up, we measured the volume of cysts, symptom scores, cosmetic scores using a visual analog scale, and related complications were examined at postoperative dates of one and six months. RESULTS: The volume of thyroid cysts were significantly reduced (p<0.01) with mean volume reduction rates of 77.3+/-21.2% at postoperative 6 months. The cosmetic score and symptom score were significantly improved following sclerotherapy (p<0.01). Major complications related to sclerotherapy, such as vocal cord paralysis, thyrotoxicosis and tissue necrosis, did not happen during the follow-up observation. CONCLUSION: USG-guided sclerotherapy could be a simple and effective treatment modality for benign cystic thyroid nodules.

Laringocele como diagnóstico diferencial de quiste tiroideo / Laryngocele as a differential diagnosis of a thyroid cyst

A cervical mass is a usual complaint within the clinical practice. Among possible causes, thyroid cysts and nodules are frequent findings. However, there are differential diagnoses that arise from neighboring structures, which can be difficult to assess. We report an 18 years old male presenting with a cervical mass, clinically and ecographically suggestive of a right thyroid cyst. Fine needle aspiration was negative for neoplastic cells. Within surgery a paratracheal lesion was identified and resected. The histological findings were compatible with a laryngocele. A laryngocele is an abnormal dilatation of the laryngeal sacule that can simulate a thyroid cyst. Computarized tomography and magnetic resonance are of great importance in its diagnosis, but sometimes is found within surgery or in the anatomopathologic study.

Las masas cervicales son un motivo de consulta usual dentro de la práctica clínica. Dentro de estas, los nódulos y quistes de origen tiroideo son hallazgos frecuentes. Aún así, existen diagnósticos diferenciales originados de estructuras vecinas a la glándula tiroides, cuyo diagnóstico inicial es difícil. Presentamos el caso de un varón de 18 años con una masa cervical derecha, clínica y ecográficamente sugerente de un quiste tiroideo. La punción-aspiración con aguja fina fue negativa para células neoplásicas. En el intraoperatorio se identificó una lesión paratraqueal derecha que fue resecada. El diagnóstico histológico fue compatible con un laringocele. El laringocele es una dilatación anormal del sáculo laríngeo que puede simular un quiste tiroideo. La tomografía computarizada y la resonancia magnética son de gran utilidad en su diagnóstico, pero en ocasiones éste se realiza en el intraoperatorio o mediante el estudio anatomopatológico.

Sonographic Detection of Intrathyroidal Branchial Cleft Cyst: A Case Report

We report here on an extremely rare case of an intrathyroidal branchial cleft cyst. Intrathyroidal branchial cleft cyst is rare disease entity and it has nonspecific findings on sonography, so the diagnosis of the lesion is very difficult. However, during aspiration, if pus-like materials are aspirated from a thyroid cyst, we should consider the possibility of intrathyroidal branchial cleft cyst in the differential diagnosis.

Carcinoma papilar quístico y del tiroides: Estudio de 4 casos / Tryroid cyst papillary carcinoma: Study of four cases

Se presentaron 4 casos de carcinoma papilar quístico en el período de 4 años. Se realizó examen físico de todos los casos; se encontró una masa cervical firme en la cara anterior del cuello y en 2 de ellos, se palparon adenopatías cervicales. Se aplicaron técnicas de imagen (ecografía cervical y gammagrafía tiroidea); se completó el estudio con BAAF, que tuvo valor diagnóstico en el 75 % de los casos. Se realizó un estudio anatomopatológico de todas las piezas obtenidas. Se hizo la resección del quiste, biopsia intraoperatoria y si se confirmó el diagnóstico de carcinoma papilar quístico, se le realizó una tiroidectomía total y si fue necesario, linfadenectomía. Se completó el tratamiento con I131 a dosis ablativa y tratamiento hormonal supresor de la TSH. Se destacó el papel de la BAAF en el estudio preoperatorio.

4 cases of cyst papillary carcinoma in a period of 4 years were presented. All of them underwent physical examination. A firm cervical mass was found in the anterior side of the neck and cervical adenopathies were palpated in 2 of them. Imaging techniques (cervical echography and thyroid gammagram) were applied. The study was completed with FNAB, which had a diagnostic value in 75 % of the cases. An anatomopathological study of all the pieces obtained was conducted. Resection of the cyst and intraoperatory biopsy were performed. In those cases with confirmed diagnosis of cyst papillary carcinoma, total thyroidectomy was carried out and, if necessary, lymphadenectomy. The treatment was concluded with I131 at ablative doses and TSH -supressing hormonal treatment. The role of FNAB in the preoperative study was stressed.

Vascular Endothelial Growth Factor in Cystic Fluid of Degenerative Cysts of Thyroid and Its Significance of Reaccumulation of Cystic Fluid Following Aspiration / 대한내분비외과학회지

PURPOSE: VEGF, a potent angiogenic factor, increases vascular permeability and induces the fluid accumulation in the peritoneal and pleural cavities. This study is designed to know whether the VEGF concentration are associated with the formation of cystic fluid of thyroid nodules and the results of treatment. METHODS: To know whether thyroid follicular cells produce VEGF, we measured the VEGF concentration in the conditioned medium after primary culture of the normal thyroid follicular cells (NT 1.0). Thirty seven patients, who had visited Ajou University Medical Center, were divided into two groups; group A (n=19) is patients whose cystic nodules disappeared completely with 1 or 2 times fine needle aspirations. In Group B (n=18), the cystic nodules recurred rapidly and required aspiration more than 3 times. Clinical records of patients were analyzed and compared with TSH and VEGF levels in cystic fluids. RESULTS: The VEGF concentration in basal conditioned medium were 8.2±1.2 ng/ml in NT 1.0 and 8.2±0.6 ng/ml in thyroid cancer cell line (FTC-133). NT 1.0 was not affected by TSH stimulation. Mean concentration of TSH of all cystic fluids was 4.36µIU/ml (0.13~21.7) and there was no difference between 2 groups. Mean concentration of VEGF of all cystic fluids was 140.7 ng/ml (11.1~688.8). The VEGF concentration (287.9±289.6 ng/ml) in group B was significantly higher than that (104.2±97.1 ng/ml) in group A (P<0.05). CONCLUSION: This study suggests that thyroid follicular cells produce and secrete VEGF, and VEGF is related with the accumulation of cystic fluid in degenerative cysts of thyroid. Cysts with high VEGF concentration promote rapid reaccumulation of the cystic fluid and possibly necessitate operation in selected patients.

Sclerosing agent injection in the treatment of benign thyroid cysts / 中国微创外科杂志

Objective To investigate the feasibility of sclerosing agent injection in the treatment of benign thyroid cysts. Methods Clinical data of 60 patients with thyroid cysts, who had been treated by injection of absolute alcohol or 10% sodium chloride solution, were reviewed retrospectively. Results A total of 74 lesions existed in 60 patients, and 182 times of injection were performed, with a total cure rate of 98 3% (59/60). No complications occurred. Follow-up observations for 1～5 years (mean 2 years) found no recurrence. Conclusions Sclerosing agent injection is a feasible method for benign thyroid cysts, if an exclusion of cystic papillary carcinoma is made.

Treatment of thyroid cyst by puncture and sclerotherapy guided by color Doppler flow imaging / 中国微创外科杂志

Objective To study the value of sclerotherapy by indwelling intravenous cannula guided by color Doppler flow imaging in the treatment of thyroid cyst. Methods In the guidance of color Doppler flow imaging, the cyst was punctured with intravenous cannula. Then the cyst fluid was drawn out, the cyst cavity irrigated, and the absolute alcohol injected into. Results The treatment was completed successfully in 47 cases, without complications such as bleeding or nerve injuries. The cyst was wiped out within 1 month in 20 cases, within 3 months in 27 cases. All the 47 cases were followed for 6～12 months and no recurrence was seen.Conclusions Puncture guided by color Doppler flow imaging is safe and reliable. Use of absolute alcohol in sclerotherapy is effective.

Sclerotherapy with OK-432 for recurrent cystic thyroid nodule

We have adopted OK-432 as a sclerosing agent in the treatment of cystic predominant thyroid nodules and have analyzed our findings to assess the efficacy of intralesional instillation of OK-432. From 1992 through 1993, 48 patients with recurrent or progressive cystic thyroid nodules after 2 or 3 aspirations alone, and whom were cytologically negative for malignancy, were used for this study. The OK-432 solution was prepared by dissolving 0.1 mg of OK-432 in 2 ml of physiologic saline and it was instilled in the amount of 1/10-to-1/5 of the aspirated cystic fluid. A repeated course of therapy was given up to 3 times when sufficient resolution was not obtained 4-to-6 weeks after treatment. The mean number of treatment sessions per patient was 1.5. Throughout the follow-up period from 30-to-45 months (mean, 38 months), 32 (66.7%) patients experienced an almost complete disappearance ( 0.5 cm in diameter) of the initial cyst size, and none of these patients required further treatment. The remaining 4 (8.3%) patients showed insufficient resolution despite 3 courses of therapy and 2 of these patients underwent thyroidectomy, in which the lesion proved benign in both cases. All of the patients tolerated the sclerotherapy well. No significant local complications attributed to this treatment were observed. However, a low-grade fever was observed in 26 (54.2%) patients for 2 to 5 days after instillation, which subsided with symptomatic treatment. On the basis of our experience, OK-432 sclerotherapy appears to be safe, simple and effective, and can be a useful alternative treatment for cystic thyroid nodules.

Insulin Like Growth Factor-I and Insulin Like Growth Factor Binding Protein-3 in Human Thyroid Cystic Fluids / 대한내분비학회지

In the thyroid tissue, thyrotrophin(TSH) and IGF-I played major role of the goitrogen. But the evidences and precise mechanism of these two factors were not known so much. Actually local secretion of thyroid IGF-I was originated from its fibroblasts mainly. We guessed major roles of IGFs in the thyroid tissue were local paracrine effect of thyroid cells proliferation and differentiation which concert with TSH. Recently, some reporters described the source of thyroid IGF-I were partly from thyroid follicular cells and its action were synergistic with TSH. We measured TSH, IGF-I and IGFBP-3 from sera and thyroid cystic fluids in 36 patients with simple thyroid cyst and examined into correlation between TSH, IGF-I and IGFBP-3.1) According to cyst/serum TSH ratio, we classified two groups(Group I; c/s TSH 1, n=17). This classification criteria means that cystic TSH level were increased than that of serum or not.2) The serum TSH, IGF-I and IGFBP-3 levels are not difference between group I and II.3) Cystic TSH were dependent on the serum TSH in Group I, but negative correlation in Group II. In Group II, cystic TSH was significant increased.4) Serum IGF-I were positive correlation in each Group5) In Group II, cystic IGF-I was not exceed than those of serum IGF-I, but some cystic IGFBP-3 were more increased than those of serum.6) In Group II, cystic IGFBP-3 increased than serum TSH, and cystic IGFBP-3 was positive correlation with cystic TSH and cystic IGF-I.As these data suggested that cystic TSH and cystic IGF-I levels may influence cystic IGFBP-3 level. The main effect for maintenance of cyst was mediated by cystic TSH and cystic IGFBP-3. But the cystic IGFBP-3 has major role for thyroid cyst than cyst TSH.