Single-session ethanol ablation in the treatment of thyroid cysts ≥10 mL

Background: Ethanol ablation (EA) has been proposed as a first-line treatment modality for recurrent symptomatic cystic thyroid nodules following initial aspiration. The efficacy of EA can be compromised when the initial nodule volume exceeds 10 mL. This study assessed the efficacy of single-session EA in managing thyroid cysts with an initial volume of ≥10 mL. Methods: This retrospective study included 70 patients, stratified into three groups on the basis of initial nodule volume: Group 1 (≥10, <20 mL), Group 2 (≥20, <40 mL), and Group 3 (≥40 mL). Primary outcomes were the volume reduction ratio (VRR) and therapeutic success rate (VRR >50%) at the 6-month follow-up post-EA. Secondary outcomes included improvements in symptom scores, cosmetic grades, and identification of factors influencing VRR. Results: The median VRR at the 6-month was 94.8% (interquartile ranges: 88.3–98.1%), with a therapeutic success rate of 90%. Significant improvements were observed in nodule volume, symptom scores, and cosmetic grades (all p < 0.001). Nodules ≥40 mL had poorer symptom scores and cosmetic grades compared to nodules with volumes of ≥10 mL and <20 mL (p < 0.05), though VRR differences were not significant (p = 0.944). Solid portions and nodule vascularity negatively impacted VRR (p = 0.001 and p = 0.002). Conclusion: Single-session EA effectively reduces volume and improves symptoms and cosmetic outcomes for cystic thyroid nodules ≥10 mL, though larger, solid, and vascular nodules may require tailored treatment strategies.