Session: MON 471-496-Thyroid Neoplasia & Case Reports
Poster Board MON-476
With the advancement of interventional radiology in recent years, selective embolization of thyroid arteries (SETA) has become an attractive technique in the treatment of thyroid diseases due to its minimally invasive nature.
We describe a case of voluminous cervicomediastional goiter in a 69-year-old female, who presented with progressive hoarseness of voice. Physical examination revealed a large thyroid gland weighing approximately 300 g on palpation in a euthyroid patient. Computed tomography (CT) scan of the neck and thorax revealed a large left thyroid mass extending into the mediastinum, causing deviation of the trachea and displacement of the surrounding structures, including prevertebral muscles. Left thyroid lobe measured 5.8 cm x 11.3 x 9.0 cm. Surgical resection of goiter was attempted, but aborted due to the risk of intraoperative hemorrhage from the large vessels entangling the mass. Conventional cerebral angiography demonstrated a large hypervascular left thyroid mass. Selective embolization of left thyrocervical trunk, using gelatin sponge particles, was performed. After embolization, the patient was treated with corticosteroid drug therapy and antithyroid agents. CT scan obtained 10 days after embolization showed the cervicomediastinal goiter unchanged in volume, but diffusely hypodense compared to the pre-embolization scan. A month later, CT scan showed an interval decrease in the size of left thyroid mass, measuring 5.5 x 10 x 8.0 cm. Patient’s compressive symptoms resolved. Marked visible reduction of goiter, weighing 100 g on palpation was noted on physical examination. Subsequent CT scans have shown gradual decrease in the size of goiter and thyroidectomy is no more considered as a required treatment.
As seen in this case, SETA, a safe and minimally invasive technique, can markedly reduce the size of a voluminous cervicomediastinal goiter and also resolve compressive symptoms. While thyroidectomy is the traditional treatment of large thyroid masses, use of SETA has been recently reported as a preoperative procedure aiming at thyroid volume reduction of large, benign and malignant thyroid masses.
Our case demonstrates that SETA can be useful as a sole treatment modality in large cervicomediastinal goiters. Hypervascularity of large goiters poses a challenge to thyroid resection and represents a significant risk factor for intraoperative bleeding. Although selective embolization of thyroid arteries cannot be recommended as a routine intervention, it may be a reasonable option for treatment of large cervicomediastinal goiters and an alternative to thyroidectomy in patients at high surgical risk or in whom surgery is contraindicated.
Nothing to Disclose: RD, KK, REI
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