Selective embolization of thyroid arteries as an alternative treatment of amiodarone-induced hyperthyroidism

Abstract

Background: A selective embolization of thyroid arteries (SETA) is a rarely performed procedure. Although 35 years have passed since the first description of the SETA application, only about 150-200 procedures have been published so far. Case presentation: We present the case of a patient successfully treated for amiodarone-induced hyperthyroidism using the SETA method. Patient had a history of paroxysmal atrial fibrillation (PAF), diagnosed three years earlier, treated with an anticoagulant - rivaroxaban. During 35 months, amiodarone was used as a method for treating the PAF. During the treatment, the patient developed hyperthyroidism. The patient was treated with thiamazole, propranolol and sodium perchlorate. After obtaining euthyreosis, SETA was performed. The patient underwent selective embolization of the left superior and right inferior thyroid arteries with a sclerosing agent – polyvinyl alcohol with good clinical effect. A thyrosthetics agents were discontinued. Conclusions: This case demonstrates difficulties in differential diagnosis of the type of amiodarone-induced hyperthyroidism. Normal ultrasound image of the thyroid gland and absence of antithyroid antibodies suggests type II of amiodarone-induced hyperthyroidism. While, a good, fast response to thyrostatics – type I. It seems, therefore that, the diagnosis of the mixed type of amiodarone-induced hyperthyroidism is justified. Further research are also required to assess the safety and efficacy of SETA in amiodarone-induced hyperthyroidism in larger groups of patients.