Beyond Percutaneous Ablation: Can IR Offer Embolic Therapy to Treat Thyroid Disease?

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  Review the complex anatomy of the thyroid gland, its blood supply, and surrounding structures;
  



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  Discuss thyroid artery embolization (TAE) procedural techniques;
  



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  Review existing TAE literature and implications for current and future applications
  

Thyroid nodular disease is a common disorder in the United States that carries a low risk of malignancy. Tens of thousands of surgical thyroidectomies are performed each year for cosmetic or compressive symptoms (1).  To lessen the morbidity associated with these surgeries, percutaneous thyroid nodule ablation is emerging as a safe and effective alternative to surgery. Ablation techniques are, however, limited by size and location of nodular disease, and most effective in patients with few small to medium sized nodules < 30-50cc. TAE is a safe procedure that allows for treatment of any sized thyroid nodules including those inaccessible from a percutaneous approach (2).

TAE was first described in the early 1990s as a treatment for Graves’ Disease. Literature over the next several decades focused on treating hyperfunctioning nodules with secondary benefit of reducing overall thyroid gland size (3,4). Volume reduction has recently been used as a primary endpoint for TAE in patients with large or recurrent nodular disease. Thyroid nodule volume reduction with particle TAE ranges from 50-80% with added benefit of maintaining a euthyroid state. The maximum effect is experienced six months after treatment, though patients describe immediate improvement in symptoms as arterial pulsation and tinnitus are resolved following embolization (2,5).

Clinical Findings/Procedure Details: This educational exhibit will: 

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  Provide detailed review of the thyroid gland and vascular supply with CT and angiographic correlation;
  



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  Review existing literature regarding the safety and efficacy of TAE;
  



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  Compare TAE to existing treatments including thyroidectomy, percutaneous ablation, and radioiodine therapy;
  



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  Provide procedural techniques for catheter-based imaging and selecting of the thyroid arteries, and particle embolization endpoints;
  



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  Provide recommendations for patient selection and procedural adjustment in specific subgroups of patients
  

TAE is a safe and effective procedure that provides IR with the ability to treat a wider array of thyroid nodular disease. Potential indications include large nodules with retrosternal or intrathoracic components, toxic nodules to precipitate euthyroid state, delay rapidly growing nodules, and provide preoperative hemostatic control.