Thyroid functional autonomy — sclerotherapy and radioactive iodine therapy: case report

Thyroid functional autonomy (TFA) is the most frequent reasons of subclinical or manifest thyrotoxicosis. Diagnosis of the causes of thyrotoxicosis (destruction or increased functional activity of the thyroid tissue in nodular and diffuse thyroid pathology) is a key point in determining the management of patients with this pathology. Scintigraphy is the method of choice in differential diagnosis of the causes of thyrotoxicosis assessing the functional state of the thyroid gland. Thyroid scintigraphy can be performed using 99mTc-pertechnetate. After normalization of the level of thyroid hormones is confirmed, radical treatment is recommended. It could be surgery or radioactive iodine therapy (RAI). In some cases, especially in the elderly women, TFA is combined with thyroid nodules (TN), which can cause pressure symptoms, cosmetic complaints, and thyroid dysfunction. Minimally invasive treatments, such as percutaneous ethanol injection (PEI) sclerotherapy, has been proposed, especially for pressure symptoms and cosmetic complaints, as an alternative to surgery. The presented clinical case will demonstrate the possibility of use sclerotherapy and RAI for the successful treatment of TFA with TN.

1. Yegorycheva YeK, Troshina YeA, Abdulkhabirova FM, et al. Diagnostics and treatment of the functional autonomy of the thyroid gland. Clinical Medicine. 2006;84(9):14-21. (In Russ.).

2. Sviridenko NYu. Functional autonomy in endemic goiter. Problems of Endocrinology. 2005;51(1):40-41. (In Russ.). doi: https://doi.org/10.14341/probl200551140-41

3. Troshina EA, Sviridenko NYu, Vanushko VE, et al. Russian Association of Endocrinologists clinical practice guidelines for thyrotoxicosis diagnosis and treatment. Clinical and experimental thyroidology. 2014;10(3):8-19. (In Russ.). doi: https://doi.org/10.14341/ket201438-19

4. Sviridenko NV. Skleroterapija uzlovyh obrazovanij shhitovidnoj zhelezy pri funkcional’noj avtonomii. [dissertation] Moscow; 2010. (In Russ.).

5. Egorycheva EK, Troshina EA, Abdulhabirova FM, et al. Diagnostics and treatment of the functional autonomy of the thyroid gland. Clinical Medicine. 2006;84(9):14-21. (In Russ.).

6. Abdulkhabirova FM, Bezlepkina OB, Brovin DN, et al. Clinical practice guidelines “Management of iodine deficiency disorders.” Problems of Endocrinology. 2021;67(3):10-25. (In Russ.). doi: https://doi.org/10.14341/probl12750

7. Kim IV. Miniinvazivnye tehnologii i organosohranjajushhie operacii v lechenii dobrokachestvennyh zabolevanij shhitovidnoj zhelezy. [dissertation]. Moscow; 2005. (In Russ.).

8. Hahn SY, Shin JH, Na DG, et al. Ethanol ablation of the thyroid nodules: 2018 Consensus statement by the Korean society of thyroid radiology. Korean J Radiol. 2019;20(4):609. doi: https://doi.org/10.3348/kjr.2018.0696

9. Crescenzi A, Papini E, Pacella CM, et al. Morphological changes in a hyperfunctioning thyroid adenoma after percutaneous ethanol injection: Histological, enzymatic and submicroscopical alterations. J Endocrinol Invest. 1996;19(6):371-376. doi: https://doi.org/10.1007/BF03344972

10. Pomorski L, Bartos M. Histologic changes in thyroid nodules after percutaneous ethanol injection in patients subsequently operated on due to new focal thyroid lesions. APMIS. 2002;110(2):172-176. doi: https://doi.org/10.1034/j.1600-0463.2002.100208.x

11. Zieleźnik W, Sieroń A, Peszel-Barlik M, et al. Przezskórna alkoholowa sklerotyzacja łagodnych guzków tarczycy [Alcohol sclerotherapy for benign solitary thyroid nodules]. Wiad Lek. 1997;50(7-9):211-216.

12. Peng S, Liu Y, Lv W, et al. Deep learning-based artificial intelligence model to assist thyroid nodule diagnosis and management: a multicentre diagnostic study. Lancet Digit Heal. 2021;3(4):e250-e259. doi: https://doi.org/10.1016/S2589-7500(21)00041-8