Call
(630) 938-6161
to Schedule a Consultation

25 N Winfield Rd Ste 505, Winfield, IL 60190-1295

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Call
(630) 938-6161
to Schedule a Consultation

25 N Winfield Rd Ste 505
Winfield IL 60190-1295

Procedure

Ethanol Ablation

General Information FAQ POST Procedure Risks How to Schedule
Fine Needle Aspiration Thyroid

General Information

Ethanol ablation is a procedure performed with the goal of substantially decreasing the size of a cystic (fluid filled) thyroid nodule or a thyroglossal duct cyst, and preventing the fluid from returning. 

  • Reasons to perform this procedure include predominantly cystic thyroid nodules or thyroglossal duct cysts that cause compressive symptoms (pressure in the neck, choking sensation, difficulty breathing / swallowing, etc.) or are cosmetically noticeable in the neck.
  • Ethanol ablation is not effective or recommended for solid or predominantly solid thyroid nodules.

The procedure is performed by using an ultrasound to visually guide a needle through the skin, directly into the growth.

The skin is numbed prior, which requires a pinch from a needle and stinging / burning sensation as the numbing medicine is injected. 

  • The sensation is uncomfortable but brief, like a quick bee sting.
    • This is typically the worst part of the procedure.
  • Unfortunately, the numbing medicine cannot numb the tissues deeper in the neck or the cystic mass itself.
    • As a result, you may feel pressure or discomfort when the needle goes deeper.
    • Whatever sensation you feel can travel to your jaw, ear, head, or chest because the sensation nerve fibers in the head and neck are all connected
      • If experienced, this sensation is normal and will be temporary.
Fine Needle Aspiration Thyroid

Once the needle is in the cystic mass, a syringe is used to aspirate or suck the fluid out of the mass, thus decompressing or shrinking it.

  • This takes about 2-3 minutes depending on the size of the mass.


If the fluid is only aspirated from the mass, there is a very high chance for the fluid to come back.

  • Therefore, once the fluid is drained, a very high concentration of ethanol (type of alcohol solution) is injected into the decompressed mass to encourage the cyst wall to scar down on itself and make it less likely for the fluid to come back.
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How the Ethanol is injected:

After 95% of the fluid is aspirated, the needle is left in position and the syringe full of the aspirated fluid is twisted off from the needle.

With the needle maintained in the same position, a new syringe full of the Ethanol is twisted on to the needle.

  • As the syringes are twisted on and off, you may feel a pinching sensation in the skin which is normal.

The needle is then confirmed to still be inside the cystic mass by visualizing it on the ultrasound screen and aspirating the small amount of remaining fluid into the syringe.

  • The Ethanol is then slowly injected into the cyst, carefully ensuring the alcohol is going directly into the cystic mass by visualizing it on the screen.
    • While the ethanol is being injected, the patient may feel pressure or a burning sensation, which can also spread to different parts of the head and neck.
    • During this time Dr. Kay will be speaking with the patient to ensure that they are not experiencing intolerable pressure or pain.
  • The Ethanol remains in place for 3 minutes, after which all the Ethanol and any remaining fluid is aspirated from the cystic mass.

The needle is then removed from the neck.

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The needle is typically in the neck for about a total of ~ 5-7 minutes before it is removed.

  • While the needle is in the neck, the patient should try to remain very still, avoiding turning their neck, swallowing, or talking (unless directly being asked a question).
    • If the patient moves, it will make it more difficult for the person performing the procedure (possibly resulting in a less effective outcome), and potentially cause more discomfort for the patient.

The entire procedure takes about 5 – 10 minutes.

Ethanol Ablation

Frequently Asked Questions

Success rates depend on how cystic the thyroid nodule is and are highest when:

  • The mass is mostly or completely fluid filled (very little solid tissue).
  • The fluid is in one common space, and not in multiple spaces divided by partitions / solid portions.
  • The fluid is thin in nature and easy to aspirate with the needle, not thick or viscous (unfortunately this cannot be determined until the procedure is performed).
    • Overall, for cystic masses that are deemed good candidates, meaningful and sustained reduction in size occurs ~ 80% of the time.

Thyroid nodules that are predominantly cystic and deemed good candidates for Ethanol ablation are considered TR 1 (benign) or TR 2 (non-suspicious) risk thyroid nodules and therefore there is no indication for sending cells to rule out cancer.

Thyroglossal duct cysts that are completely cystic are also considered benign and therefore there is no indication for sending cells to rule out cancer.

The Ethanol ablation can be performed on the same day of the consultation in the office, with the entire visit lasting ~ 40 min.

Yes, it is safe for you to drive home from after the procedure.

You can take an anti-anxiety medication at the appropriate amount of time before the procedure.

Please have someone bring you to the office visit and drive you home after taking the anti-anxiety medication.

Repeat Ethanol ablation can be considered if there was a partial improvement and the cystic mass is still deemed to be a good candidate based on its appearance.

Otherwise, the options are continued observation with repeat ultrasounds vs surgery to remove the cystic thyroid nodule or thyroglossal duct cyst if the compressive symptoms are severe enough or continued growth is noted over time.

Fine Needle Aspiration Thyroid

Risks of an Ethanol Ablation

What are the risks of an Ethanol ablation?

Sometimes the fluid is too thick to suck out with a needle and therefore the procedure cannot be performed.

  • If the fluid cannot be aspirated, the Ethanol will not be injected because it will be ineffective.

Unfortunately, there is no way to tell if the fluid is too thick until the procedure is attempted.

Sometimes despite a properly performed procedure, the fluid of the cystic mass can return.

  • In general, this risk for this is 20%, possibly higher if the mass is not completely cystic or composed of multiple pockets of fluid (as opposed to one large common pocket).
  • If the fluid does return, a repeat Ethanol ablation can be considered if it remains a good candidate.

Introducing a needle into any cystic mass has a risk of causing infection in the cyst.

The risk for infection with Ethanol ablation is low, ~ 2%.

Signs of infection include redness, swelling, and pain near the procedure sight.

  • If you are experiencing these symptoms, please call the office at 630.938.6161; you will likely need to be started on an antibiotic to treat the infection.

Bleeding during or after Ethanol ablation resulting in significant swelling and bruising (aka hematoma) is very rare; < 1%.

  • This will present as significant swelling and bruising in the neck.
    • Please call the office at 630.938.6161 right away if you experience anything more than a small amount of bruising and swelling.
    • Very rarely can bleeding persist requiring admission to the hospital.
  • More common when patients are on multiple blood thinning medications.
    • If taking a single blood thinner, it is ok to proceed with the Ethanol Ablation with an acceptable slight increased risk of bleeding to ~ 1%.
  • If taking multiple blood thinners, you may be asked to stop one or all prior to the procedure to limit this risk.

How Do I Schedule an Ethanol Ablation?

You can call 630.938.6161 and ask to schedule a consultation with ethanol ablation.

The consultation and Ethanol ablation can be performed on the same day, with the entire appointment taking ~ 40 min.

Call (630) 938-6161 to schedule