Evaluation of selective embolization of thyroid arteries (SETA) as a preresective treatment in selected cases of toxic goitre

Marek Dedecjus,Arkadiusz Zygmunt,Jan Brzeziński,Józef Tazbir,Andrzej Lewiński,Zbigniew Kaurzel,Grzegorz Stróżyk

doi:10.1186/1756-6614-2-7

Abstract

Backgroundin recent years, an increasing interest in the application of selective embolization of thyroid arteries (SETA) in the treatment of thyroid diseases is observed. In the present report, we analyse the value, safety and possible indications for preresective SETA in cases of large toxic goitres.Patients and methodthe study group comprised 10 patients with large toxic goitre (thyroid volume 254 ± 50 mL), including one patient with cervicomediastinal goitre and one patient with anti-thyroid drug intolerance in state of overt thyrotoxicosis. All the patients underwent SETA of the superior and/or inferior thyroid arteries, followed by thyroidectomy, performed up to thirty-six hours after SETA (23.1 ± 11 h). After embolization, selective angiographies of thyroid arteries were performed to ensure that the targeted arteries had been completely occluded.Results and conclusionin all the patients, SETA decreased blood flow through the thyroid. Preresective SETA reduced blood loss during and after thyroidectomy and decreased the operating time, but the differences were too small to justify routine applications of preresective SETA as an adjunct to surgical treatment of toxic goitre. On the other hand, SETA is a safe and minimally-invasive technique, which may become an attractive option for quick preparation to surgery in selected patients with toxic goitre, who present anti-thyroid drug intolerance or refuse radioactive iodine treatment.

Highlights

Embolization of vascular tumours of the head, the neck and the central nervous system (CNS) has become an important adjunct to treatment of these pathologies
The published reports are limited to the applications of selective embolization of thyroid arteries (SETA) in treatment of thyrotoxicosis – in Graves' disease [35] – and thyroid cancer [6,7,8]
We retrospectively compared the operations of investigated patients with the twenty operations of toxic goitre of similar volume, performed without prior preresective SETA

Summary

Introduction

Embolization of vascular tumours of the head, the neck and the central nervous system (CNS) has become an important adjunct to treatment of these pathologies. Embolization techniques have been employed more commonly and with higher precision and facility. As a result, this alternative technique has quickly evolved into the first-line therapy for many complex clinical conditions, surgical repairs of which are considered to bear high risk of various degrees. This alternative technique has quickly evolved into the first-line therapy for many complex clinical conditions, surgical repairs of which are considered to bear high risk of various degrees The introduction of this procedure has improved morbidity and mortality rates of patients with tumours of the head, the neck and the central nervous system, while facilitating their removal [1,2]. The published reports are limited to the applications of SETA in treatment of thyrotoxicosis – in Graves' disease [35] – and thyroid cancer [6,7,8]

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