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

Dedecjus M, Tazbir J, Kaurzel Z, Strózyk G, Zygmunt A, Lewiński A, Brzeziński J - Thyroid Res (2009)

Bottom Line: in recent years, an increasing interest in the application of selective embolization of thyroid arteries (SETA) in the treatment of thyroid diseases is observed.After embolization, selective angiographies of thyroid arteries were performed to ensure that the targeted arteries had been completely occluded. in all the patients, SETA decreased blood flow through the thyroid.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland. alewin@csk.umed.lodz.pl.

ABSTRACT

Background: in 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 method: the 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 conclusion: in 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.

No MeSH data available.


Related in: MedlinePlus

Patient No 10: photo of the patient before the procedures (on the left), state after embolization of the right superior and right inferior thyroid arteries and during arteriography of the left inferior artery (in the middle), state after embolization of the right superior and both inferior thyroid arteries, during arteriography of the left superior thyroid artery (on the right) – the artery was not embolized because of the communication with the left sublingual artery.
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Figure 3: Patient No 10: photo of the patient before the procedures (on the left), state after embolization of the right superior and right inferior thyroid arteries and during arteriography of the left inferior artery (in the middle), state after embolization of the right superior and both inferior thyroid arteries, during arteriography of the left superior thyroid artery (on the right) – the artery was not embolized because of the communication with the left sublingual artery.

Mentions: In all the patients, thyroidectomy was performed before the 36th hour after SETA. Nine patients demonstrated toxic goitre at the stage of either euthyroidism or subclinical hypothyroidism (Table 1). One of the above patient had retrosternal goitre. In all the cases, SETA effectively limited blood flow through the thyroid gland – confirmed in DSA (Figures 1, 2, 3), CT scans (Figure 2) and US-scan. We retrospectively compared the operations of investigated patients with the twenty operations of toxic goitre of similar volume, performed without prior preresective SETA (patient were not randomized). The application of SETA significantly shortened the operating time and reduced drainage and blood loss during thyroidectomy (Table 2). On the other hand, preresective SETA had no influence on the rate of complications. No major complications were observed, except haematoma (2 cases), fever (2 cases) and neck pain (2 cases).


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

Dedecjus M, Tazbir J, Kaurzel Z, Strózyk G, Zygmunt A, Lewiński A, Brzeziński J - Thyroid Res (2009)

Patient No 10: photo of the patient before the procedures (on the left), state after embolization of the right superior and right inferior thyroid arteries and during arteriography of the left inferior artery (in the middle), state after embolization of the right superior and both inferior thyroid arteries, during arteriography of the left superior thyroid artery (on the right) – the artery was not embolized because of the communication with the left sublingual artery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2734524&req=5

Figure 3: Patient No 10: photo of the patient before the procedures (on the left), state after embolization of the right superior and right inferior thyroid arteries and during arteriography of the left inferior artery (in the middle), state after embolization of the right superior and both inferior thyroid arteries, during arteriography of the left superior thyroid artery (on the right) – the artery was not embolized because of the communication with the left sublingual artery.
Mentions: In all the patients, thyroidectomy was performed before the 36th hour after SETA. Nine patients demonstrated toxic goitre at the stage of either euthyroidism or subclinical hypothyroidism (Table 1). One of the above patient had retrosternal goitre. In all the cases, SETA effectively limited blood flow through the thyroid gland – confirmed in DSA (Figures 1, 2, 3), CT scans (Figure 2) and US-scan. We retrospectively compared the operations of investigated patients with the twenty operations of toxic goitre of similar volume, performed without prior preresective SETA (patient were not randomized). The application of SETA significantly shortened the operating time and reduced drainage and blood loss during thyroidectomy (Table 2). On the other hand, preresective SETA had no influence on the rate of complications. No major complications were observed, except haematoma (2 cases), fever (2 cases) and neck pain (2 cases).

Bottom Line: in recent years, an increasing interest in the application of selective embolization of thyroid arteries (SETA) in the treatment of thyroid diseases is observed.After embolization, selective angiographies of thyroid arteries were performed to ensure that the targeted arteries had been completely occluded. in all the patients, SETA decreased blood flow through the thyroid.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland. alewin@csk.umed.lodz.pl.

ABSTRACT

Background: in 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 method: the 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 conclusion: in 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.

No MeSH data available.


Related in: MedlinePlus