News — WINSTON-SALEM, N.C. – Oct. 12, 2018 –If you have a thyroid problem, a shot of alcohol just might be the cure.
But hold off on heading to the liquor store: It’s not that kind of shot or that kind of alcohol.
Instead, it’s a medical procedure called ultrasound-guided percutaneous ethanol ablation, which involves the pinpoint injection of medical-grade alcohol into the neck to destroy harmful cells. Two of its principal uses are treating fluid-filled thyroid cysts and thyroid cancer that has spread to nearby lymph nodes.
“Ethanol ablation is a minimally invasive therapy option for several thyroid conditions,” said Brittany Henderson, M.D., assistant professor of endocrinology and metabolism at Wake Forest Baptist Medical Center. “It’s a low-risk alternative to surgery, it’s quick and cost-effective, and the side effects are about the same as those from a flu shot.”
Because the thyroid – a butterfly-shaped gland located at the base of the neck – produces essential hormones that regulate vital functions such as heart rate, breathing and body temperature, you’d think any procedure that’s proven effective in addressing thyroid problems would be widely practiced.
But that’s not the case with ethanol ablation, at least in this this country – even though it was first employed more than 25 years ago.
“The procedure has been around a long time in Europe, and the Mayo Clinic in Minnesota has a lot of experience with it, but there really aren’t that many centers in the U.S. that offer it,” said Henderson, who is director for thyroid and endocrine neoplasia services at Wake Forest Baptist’s Comprehensive Cancer Center. “There’s not a widespread awareness of this as a viable option for patients.”
The main reason for that, she said, is lack of training.
“There’s nothing formalized in medical education, and some of the centers that do it don’t readily teach people, unfortunately,” said Henderson, who learned how to perform ethanol ablation at the Thyroid Center of Santa Monica in California. “A lot of people are being sent to surgery because there’s no provider in their community that does it.”
While the procedure does require special training, the principle underlying ethanol ablation is rather simple: The alcohol is an irritant that blocks the supply of blood to the problem cells, effectively killing them.
At Wake Forest Baptist – where endocrinology residents will be taught how to execute the procedure – ethanol ablation for thyroid conditions was introduced in September 2017 and has been performed on approximately 40 patients, with a success rate around 95 percent.
“The results we’ve had are pretty consistent with the published literature,” Henderson said. “Within three to six months, there’s been about an 80 percent decrease in the size of both the cysts and lymph nodes, which essentially resolves the problems.”
Thyroid cancer is relatively uncommon, with approximately 65,000 new cases reported annually in the United States, according to the American Thyroid Association, and one of the least aggressive forms of cancer.
“People diagnosed with stages 1, 2 or 3 have a lifetime survival rate way over 90 percent,” Henderson noted.
But it is also the fastest growing form of cancer in women, who account for 75 percent of all cases.
And even after it is removed through surgery or another therapy, thyroid cancer has a nasty of habit of returning, particularly in the lymph nodes, sometimes many years after the initial treatment.
“Recurrence is definitely not uncommon; it happens between 30 and 60 percent of the time,” Henderson said. “In these cases people will usually need three or four surgeries, which are invasive, costly and create scar tissue, which can make each successive surgery more difficult and increase the risk of complication. But with ethanol ablation we can kill of the blood supply to the lymph nodes, shrink them and get rid of the cancer cells without an operation.”
The fluid-filled thyroid cysts that ethanol ablation is used on are rarely malignant, but that doesn’t mean they’re harmless.
The cysts can be large enough to be visible on the neck or cause deviation of the trachea (windpipe) that may produce persistent cough, shortness of breath or difficulty swallowing.
The first treatment is usually to drain the fluid from the nodule, Henderson said. But when that doesn’t work, ethanol ablation is available as an alternative to surgery.
“After treatment with alcohol you have cosmetic improvements and resolution of symptoms,” she said. “The procedure is not invasive, it takes about 20 minutes as opposed to three or four hours for surgery, it’s done right in the office with a local anesthetic instead of general anesthesia in an operating room, it’s painless and costs less than one-tenth what surgery does.
“We just need to train more physicians how to do it.”
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