Thyroid Embolization for Nonsurgical Treatment of Nodular Goiter: A Single-Center Experience in 56 Consecutive Patients

Role of Locoregional Therapies in the Treatment of Thyroid Pathology: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel

The role of locoregional therapy in the management of thyroid pathology is rapidly evolving. The Society of Interventional Radiology (SIR) Foundation commissioned an international research consensus panel consisting of physicians from multiple disciplines with expertise in the management of benign and malignant thyroid disease. The panel focused on identifying gaps in the current body of literature to establish research priorities that have the potential to shape the landscape of minimally invasive thyroid interventions. The topics discussed were centered on the emerging role of ablation for malignant thyroid tumors and the treatment of large functioning nodules with embolization and ablation. Specifically, the panel prioritized identifying nodule characteristics, including size and location, that are associated with ideal outcomes following thermal ablation for papillary thyroid microcarcinoma through the development of an international registry or a prospective, multi-institutional trial. The panel also prioritized evaluating the role of locoregional therapy in Stage T1b papillary thyroid cancer through a sequence of 2 studies: (a) a Phase I study of ablation followed by immediate resection of Stage T1b papillary thyroid cancer, which may lead to (b) a Phase II prospective, multi-institutional study of ablation followed by biopsy for Stage T1b papillary thyroid cancer. Lastly, the panel prioritized investigating the treatment of large, functioning thyroid nodules >20 mL in volume through a randomized clinical trial or prospective registry comparing embolization alone with embolization followed by ablation.

Non-Surgical Approaches to the Management of the Intrathoracic Goiter-A Systematic Review

BACKGROUND

Intrathoracic goiters (ITGs) are usually managed by surgical excision, However, over recent years, non-surgical strategies are emerging as an alternatives for treating this condition.

METHODS

A systematic review of research published since 2017 in the PubMed database was conducted and a total of 39 articles were retrieved, along with methodological issues and future directions in the research on ITGs.

RESULTS

Several non-surgical treatments exist, including radio-iodine ablation (RIA) and mini-invasive approaches, such as transcervical microwave ablation (TcMA), transcervical radiofrequency ablation (TcRfA), or selective embolization of the thyroid arteries (SETA). Despite encouraging reports, their current use remains limited.

CONCLUSIONS

Treatment of ITGs requires a multidisciplinary thyroid team, and when non-surgical options are chosen, patients need to be carefully selected, and their outcomes must be prudently considered and discussed with the patient.

Superior thyroid artery injury following foreign body ingestion in an intellectually disabled patient: A case report

This case report highlights complexities in an intellectually disabled adult who ingested a chicken bone, resulting in a rare complication-superior thyroid artery injury. Presentation, diagnostic challenges, and a multidisciplinary approach are detailed. Initial attempts at esophagoscopy under general anesthesia were hindered by blood coughing, leading to a change of plan. Subsequent findings revealed mucosal edema and continuous bleeding from the site. Challenges in anesthetizing intellectually disabled individuals are emphasized, stressing tailored induction methods. The case concluded with successful embolization but developed neurological complication which was successfully managed showcasing the significance of a collaborative and adaptable approach.

Current role of interventional radiology in thyroid nodules

Thyroid nodules are a prevalent health issue in society. Interventional radiological methods are successfully applied for both the diagnosis and treatment of nodules. Diagnostically, a fine-needle aspiration biopsy and a core needle biopsy can be performed to ascertain the benign or malignant nature of a lesion. In recent years, imaging-guided percutaneous treatment methods have become popular in the treatment of thyroid nodules. Aspiration, ablation, and embolization are techniques employed in the treatment process. In this study, we aimed to discuss the current role of interventional radiology in the diagnosis and treatment of thyroid nodules, which occupy an important place in clinical practice.

Thyroid Artery Embolization for Tracheostomy Site Bleeding: A Report of Three Cases

In this case report, the authors present three cases of post-tracheostomy site bleeding successfully treated using embolization, supplemented by CT and angiography images. This report highlights that embolization can be a viable alternative when surgical or endoscopic interventions fail or are not applicable in cases of post-tracheostomy bleeding.

Value of interventional radiology and their contributions to modern medical systems

Interventional radiology (IR) is a unique specialty that incorporates a diverse set of skills ranging from imaging, procedures, consultation, and patient management. Understanding how IR generates value to the healthcare system is important to review from various perspectives. IR specialists need to understand how to meet demands from various stakeholders to expand their practice improving patient care. Thus, this review discusses the domains of value contributed to medical systems and outlines the parameters of success. IR benefits five distinct parties: patients, practitioners, payers, employers, and innovators. Value to patients and providers is delivered through a wide set of diagnostic and therapeutic interventions. Payers and hospital systems financially benefit from the reduced cost in medical management secondary to fast patient recovery, outpatient procedures, fewer complications, and the prestige of offering diverse expertise for complex patients. Lastly, IR is a field of rapid innovation implementing new procedural technology and techniques. Overall, IR must actively advocate for further growth and influence in the medical field as their value continues to expand in multiple domains. Despite being a nascent specialty, IR has become indispensable to modern medical practice.

Long-term outcomes of radiofrequency ablation for intrathoracic goiter up to 5 years: evaluated by computed tomography/magnetic resonance imaging and ultrasound

OBJECTIVES

This study evaluated the long-term efficacy and safety of radiofrequency ablation (RFA) for intrathoracic goiter (ITG) over a follow-up period exceeding six months.

METHODS

From 2017 to 2022, 22 patients (6 males, 16 females) with 24 ITGs treated with RFA at a single medical center were evaluated. All patients underwent ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI) before RFA. Follow-up CT/MRI was performed six months after the initial RFA and then every 6-12 months. The primary outcomes measured were the degree of extension, goiter volume, volume reduction rate (VRR), tracheal deviation, and tracheal lumen. Additionally, we assessed the outcomes of single-session RFA (n = 16) vs. multiple sessions (n = 8) on goiters and explored the correlation between ITG volume measurements obtained using ultrasonography and CT/MRI.

RESULTS

The median follow-up period was 12 months (interquartile range: 6-36.8 months). At the last follow-up, the nodule volume measured by CT/MRI had significantly decreased (76.2 vs. 24.6 mL; p < 0.05), with a VRR of 64.6%. Patients who underwent multiple RFA sessions showed a significantly higher VRR than the single-session patients (63.8 vs. 80.1%, p < 0.05). The intraclass correlation between goiter volumes measured using US and CT/MRI was moderate.

CONCLUSION

This study affirms the long-term efficacy and safety of RFA for ITG, providing an alternative treatment for nonsurgical candidates. Multiple RFA sessions may be beneficial for achieving better volume reduction. Sole reliance on ultrasonography is inadequate; therefore, integrating CT/MRI is essential for accurate pre-RFA and follow-up assessments.

Benign Thyroid Nodule Interventions: A Review and Imaging Considerations for the Interventional Radiologist

Thyroid radiofrequency ablation (RFA) is a minimally invasive procedure that can be used to treat patients with benign thyroid nodules and is a good alternative to thyroidectomy or radioactive iodine. Thyroid RFA is commonly performed with local lidocaine or minimal/moderate sedation and has a minimal risk profile and few side effects. The efficacy of thyroid RFA has been well documented in the literature, with a volume reduction rate of 67 to 75% at 1 year. Another emerging technique for nodule size reduction is thyroid artery embolization which is a minimally invasive procedure that may be performed in patients with nodular goiters, particularly with substernal thyroid nodule extension, and who are either poor surgical candidates or do not want surgery. This article reviews thyroid RFA, focusing on the relevant preprocedural, procedural, and postprocedural imaging, as well as a discussion on the emerging role of thyroid artery embolization.

The Thyroidea Ima Artery Arising from the Aortic Arch: A Rare Anatomical Variation

A 73-year-old man underwent computed tomography (CT) angiography assessment of the head and neck vasculature. An incidental note of the thyroidea ima artery arising from the aortic arch was made. Presence of thyroidea ima artery may have clinical importance prior to neck surgeries and minimally invasive interventions.

General Principles for the Safe Performance, Training, and Adoption of Ablation Techniques for Benign Thyroid Nodules: An American Thyroid Association Statement

Background: The primary goal of this interdisciplinary consensus statement is to provide a framework for the safe adoption and implementation of ablation technologies for benign thyroid nodules. Summary: This consensus statement is organized around three key themes: (1) safety of ablation techniques and their implementation, (2) optimal skillset criteria for proceduralists performing ablative procedures, and (3) defining expectations of success for this treatment option given its unique risks and benefits. Ablation safety considerations in pre-procedural, peri-procedural, and post-procedural settings are discussed, including clinical factors related to patient selection and counseling, anesthetic and technical considerations to optimize patient safety, peri-procedural risk mitigation strategies, post-procedural complication management, and safe follow-up practices. Prior training, knowledge, and steps that should be considered by any physician who desires to incorporate thyroid nodule ablation into their practice are defined and discussed. Examples of successful clinical practice implementation models of this emerging technology are provided. Conclusions: Thyroid ablative procedures provide valid alternative treatment strategies to conventional surgical management for a subset of patients with symptomatic benign thyroid nodules. Careful patient and nodule selection are critical to the success of these procedures as is extensive pre-procedural patient counseling. Although these emerging technologies hold great promise, they are not without risk and require the development of a unique skillset and environment for optimal, safe performance and consistent outcomes.

Thyroid ima artery embolization for the treatment of Graves' disease and thyroid storm

Graves' disease may be managed with thyroid embolization when other traditional strategies are less suitable. To date, no reports exist on the embolization of the thyroid ima artery for Graves' disease or the outcomes of this procedure. Here, we present a safe and successful report of thyroid ima artery embolization in a neutropenic patient with thyroid storm. A 30-year-old female with a history of Graves' disease presented to a community hospital with heat intolerance, anxiousness, tachycardia, and tachypnea. Further laboratory testing prompted the diagnosis of thyroid storm. Embolization of the thyroid was chosen for management because total thyroidectomy risked infection in the setting of methimazole-induced neutropenia. The patient's thyroid ima artery was significantly enlarged and had a large perfusion distribution across the thyroid. It was selected for embolization, along with the right superior thyroid artery, and successfully resulted in a 60% reduction of thyroid perfusion. No complications resulted from this procedure. Although the prevalence of patients with thyroid ima artery is low, this artery can be safely and effectively embolized for the management of Graves' disease and thyroid storm.

Radiofrequency Ablation for Benign Thyroid Nodules: Radiology In Training

Two patients, one with benign nonfunctioning nodules and one with functioning thyroid nodules, both of whom underwent radiofrequency ablation, are presented. Preprocedural evaluation, procedural considerations, and follow-up care of thyroid radiofrequency ablation, as well as published evidence on the topic, are discussed.