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Thyroid artery embolization
What is thyroid artery embolization?
Thyroid artery embolization (TAE) is most effective for thyroid nodules or goiters that are too large for radiofrequency ablation or another minimally invasive method. It is particularly helpful for extremely large goiters and nodules that extend below the collarbone into the chest. This type of substernal extension usually makes ultrasound-guided techniques like RFA impossible. The procedure involves the use of a vascular catheter that allows small medical treatment particles to be introduced into the artery that feeds the goiter or targeted nodule. The particles block the blood supply to the targeted tissue, causing it to die and shrink gradually over time. Embo

lization is a widely used procedure that is used very successfully to treat other types of tumors in many locations in the body. The procedure is performed by an interventional radiologist or neurointerventionalist with experience in angiography and embolization. 

How effective is thyroid artery embolization?

The goal of TAE is to dramatically reduce the size of extremely large thyroid nodules and goiters. A single-institution study of 56 patients who underwent TAE for nodular goiter demonstrated an average reduction in the volume of treated nodules of 69% and an average reduction in the volume of multinodular goiters of 57.5% by 6 months. This included a majority of patients (84%) who had a goiter that extended below the sternum into the chest. Hyperthyroidism not associated with Graves’ disease was effectively treated in 86%, but embolization improved but did not normalize thyroid function in 3 treated patients with Graves’ disease. None of the patients with normal thyroid function before embolization developed hypothyroidism after the procedure.

How is thyroid artery embolization performed?

TAE is performed in an interventional radiology procedure room or operating room and requires specialized imaging equipment capable of taking repeated or serial X-ray images (angiography). The procedure may be done either with general anesthesia which puts you to sleep, or local anesthesia with some sedation. A needle is inserted into the femoral artery (a large artery in the groin) or an artery in the wrist allowing insertion of a guide wire on which a long catheter is guided into the neck and into the arteries supplying the thyroid using angiography. Small medical treatment particles are then introduced into the artery and these block the blood supply to the targeted tissue, causing it to die and shrink gradually over time. 

What is the recovery like following thyroid artery embolization?
Immediately after the treatment pressure is placed on the groin or wrist where the artery was accessed and bedrest for at least several hours is required. You may also receive intravenous pain medication and steroids to reduce swelling in the treated areas of the thyroid. Depending on the extent of the procedure and your general health, you may be able to go home on the day of treatment, or your doctor may instead keep you in the hospital for monitoring overnight. Pain at the catheter insertion site is usually controlled with over-the-counter medications like acetaminophen (Tylenol) and topical ice packs. Bruising and tenderness around the insertion site usually resolve quickly.
What are the risks of thyroid artery embolization?

The main risk of TAE is bleeding and bruising at the catheter insertion site but this is generally minimal. If the medical treatment particles used to block the thyroid arteries travel to other locations, they can block the blood supply to other important organs, and visual blurring and even stroke have rarely been reported. Destruction of the thyroid gland by blocking the blood supply can also cause stored thyroid hormone to leak into the circulation leading to hyperthyroidism that is generally mild and resolves without treatment.

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