Symptomatic nonfunctioning parathyroid cysts: role of simple aspiration and ethanol ablation.

Objectives: To evaluate the outcomes of simple aspiration and ethanol ablation in the management of symptomatic nonfunctioning parathyroid cyst (PC).

Methods: We performed simple aspirations for 12 PCs in 12 patients from March 1997 to June 2010. PC was diagnosed if the aspirated fluid was clear colorless and showed an elevated parathyroid hormone (PTH) level. Ethanol ablation (EA) was performed for recurrent PCs. Simple aspirations were performed using 23-gauge needles and EAs using 18-gauge needles with 99% ethanol under ultrasound (US) guidance. We evaluated cyst volume, cosmetic score, symptom score, and complications.

Results: Mean follow-up period of all patients was 19.2 ± 12.9 months (median, 15.0 months; range, 7-40 months). Simple aspiration was successful in four patients, and the mean volume reduction after simple aspiration was 98.2 ± 3.5% (range, 92.9-100%). In eight recurrent cases, EA resulted in a significant decrease in volume (P=0.012), as well as in cosmetic (P=0.011) and symptom (P=0.01) scores at last follow-up; however two cases of primary failure of EA was treated by repeat EA. No major complications occurred in any patient.

Conclusions: For symptomatic nonfunctioning PCs, simple aspiration could be a first line procedure for diagnosis and treatment, while EA can be a subsequent treatment modality for recurrent cases.