Avatar universal

PEI for Hot Thyroid Nodules

Hi All,

I am not posting a question, however rather posting information regarding hyper functioning thyroid nodule treatment.  I am 26 years old and was diagnosed with mild hyperthyroidism and a "hot" or "hyper functioning" thyroid nodule about 2 years ago.  My endocrinologist placed me on 2.5 mg of Methimazole daily and this helped get my levels to normal, however he told me I must have Radioactive Iodine Therapy or partial thyroidectomy surgery to remove the lobe containing the nodule.

After close to one year of research, I found so many reviews on the potentially terrible side effects of RAI.  A woman I worked with said she had to have it completed because of thyroid cancer and it completely destroyed her body.  There are also studies showing it could potentially lead to alternative types of cancer later on.  

I also refused the surgery because my endo explained that the other half of my thyroid "might" pick up.  So I am being told I could be Hypo for the rest of my life.  Not exactly ideal either.

I researched and researched and found that in Italy (mainly), physicians were performing Percutaneous Ethanol Injections on hot thyroid nodules, with over 90% success rates.  And patients were coming out euthyroid.  However, there was NO ONE I could find in the US doing this procedure on hot nodules.  Only cystic ones.

There was a physician in LA who may have done it, however he had horrible reviews.  I called Dr. Hay's office at the Mayo Clinic in Rochester, spoke to his assistant, and she explained he only performed PEI on cancerous nodules.  

After tirelessly researching, I finally found a physician who performs this for hot nodule patients.  I cannot describe how intense this research process was for me.  Each day, I would think of a new way to Google something.  So many months with no luck.  I told myself after seeing him that I would literally post this everywhere so that people would know.  People have the right to know about this option.  I'm honestly wondering why more physicians do not do it.

His name is Dr. Dev Abraham and he is at The University of Utah.  Call his assistant, Keri and tell her your situation.  She is incredible.  Links below.


I traveled from Atlanta with my mom and I cannot describe how truly wonderful this physician is.  He was so caring, and the entire procedure/visit took about 30 mins to an hour.  He is incredibly helpful, and is overall an exceptional doctor.  He is worth the trip.  He said he plans on speaking at various conferences to physicians all over the country so that hopefully they will start performing more extensively.

Oh, and my procedure was completely covered by Humana.  I literally paid the $40 co pay, and $48 to the facility after the facility costs were run through insurance.

The ONE caveat with this type of procedure, and the ONLY reason I can partially understand why more doctors aren't doing it, is that I could need 1 or 2 more injections.  With RAI or surgery, it is typically one and done.  However, your chances of becoming Hypo are so much higher, and then the endocrinologists have a patient for life... Obviously I think the health care system is a little undermining, and I could be completely wrong.  However RAI costs a ton of money, and so does a surgery...  This entire bill was around $1600, and like I said, I paid $88 after everything was run through insurance...

I hope this helps some of you.  I honestly cannot believe how long it took to find this amazing doctor.  

I had this procedure done a little over a month ago, and will be getting my blood tested back in Atlanta at my endocrinologist's office next week.  I'll post later on the results.

Hope this helps someone.
9 Responses
Avatar universal
Thank you for sharing - I don't have this issue but I am so grateful for people like yourself taking the time to put information out there. I have no doubt someone will benefit.

Best, Kel
Avatar universal
Yes, thank you so much for sharing that information!  

I am 38 years old and just recently found out I have "hyper functioning" thyroid nodule as well.  My doctor started me on Methimazole 10 mg.

But unlike your doctor, mine was hesitant to suggest radioactive iodine therapy or surgery.  He wants me to take the medication for four weeks and see if my symptoms improve during that time.  The other two options are a last resort.
649848 tn?1534633700
While PEI may be an alternative, it should be noted that there can be a need for multiple injections to achieve complete ablation.  It's also important to note that adverse effects are not uncommon, such as pain, ethanol seepage outside the nodule, and rarer events, such as transient thyrotoxicosis and recurrent laryngeal nerve damage.  
649848 tn?1534633700
It should also be noted that many doctors do not like their names or those of their staff members, posted on online forums such as this...
Avatar universal
I really hope it helps someone!
Avatar universal
I am so glad your doctor wants you to try Methimazole out before any harsh treatments.  Best of luck to you!
Avatar universal
This is one of few examples that "new" minimal invasive methods DO work.
I put word New into quotation marks because this method is used in Europe for almost 20 years. The reason why most doctors in the US are not doing it because they are afraid they will miss cancer and will face malpractice lawsuit. Also, surgery pays more than PEI. I have similar experience with dentists who are wanted to do the often unnecessary stuff to get more money from patient or insurance.
But this is off topic discussion!!
Avatar universal
Hi there,

Thank you for your comment. I definitely have my theories as to why it is not performed more frequently in the US considering the high efficacy in Italy, and sometimes I think it's reasonable to hypothesize it is because of money...... However, I do understand the risk of cancer since a biopsy is not always 100% effective.  

What I still do not understand is, when I called the Mayo Clinic in Rochester, they ONLY do PEI on cancerous thyroid nodules.  So it's a possibility, but it must just take time and several patients for a physician to become skilled in this procedure especially when it involves cancer.... I can't really speak in an educated manner on this since I have not researched PEI for cancerous thyroid nodules extensively.

I do know that the physician I saw wanted me to have the biopsy done in house to make sure the nodule is not cancerous.  Instead I did it a couple of weeks prior at Piedmont Atlanta because I thought it would be cheaper there.  Apparently the pathology slides were proof enough to continue with the procedure.  
Avatar universal
In my opinion, it will be not a bad idea to make video testimony of the treatment and share experiences on YouTube. Just saying:(
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