What is ethanol ablation?

Ethanol ablation is a minimally invasive procedure primarily used to treat fluid-filled thyroid nodules called cysts. After draining the fluid from a cyst, pure alcohol is injected into the drained cyst cavity. This causes an inflammatory reaction that should seal the cyst shut, preventing it from refilling. Because there are no sensory nerves within the thyroid, when correctly done, the procedure is easily tolerated and discomfort is minimal.  

It may take several months to know if an ethanol ablation has successfully treated your cyst, and retreatment is sometimes necessary. Your doctor may also combine ethanol ablation with other techniques such as radiofrequency ablation or laser ablation to improve your result.

How effective is ethanol ablation?

For smaller completely fluid-filled cysts with no significant solid component, if all the cyst fluid can be successfully drained before injection of the alcohol ethanol ablation is successful up to 85-98% of the time. Success rates decrease when cysts are large, or when more than 20% of the nodule volume is solid.

How is ethanol ablation performed?

Ethanol ablation can be done in an outpatient clinic procedure room or a surgical or interventional radiology suite. The treatment usually requires less than 30 minutes. You will remain awake during the procedure and a medication like lidocaine will be used to numb the neck and capsule of the thyroid gland. After numbing the treatment area, a thin needle is inserted into the cyst using ultrasound guidance. After the cyst fluid is removed, ethanol is injected into the cavity and you’ll usually be asked to remain on your back for 5 minutes or so to allow the ethanol to remain in place. Some doctors then remove the ethanol but many others do not. Either way, you’ll then be able to go home with a small bandage on the treatment site.

What is recovery like following ethanol ablation?

After the procedure, you will be monitored for a short time to make sure you are feeling well. Discomfort after the procedure is usually minimal but you may have neck soreness for a few days and you may see some bruising. Pain medication like acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) can be used but is usually not necessary. Icing your neck for the first day after the procedure also may be helpful.  Follow-up usually involves a post-procedure office visit and neck ultrasound at 1, 6, and 12 months to determine how much the cyst has decreased in size and whether your initial treatment was sufficient.

What are the risks associated with ethanol ablation?
In general, ethanol ablation is a very safe and well-tolerated procedure and often safer than surgery. The primary risk is that the cystic nodule may recollect fluid causing the procedure to fail or the need for additional treatment. More serious but rare risks include leaking of the alcohol from the cyst, which may cause pain due to injury of the tissues around the thyroid, or injury to the nerve that controls the voice. Because ethanol ablation does not significantly injure normal thyroid tissue, there is little risk of developing hypothyroidism from the procedure itself.