Thyroid Embolisation

Thyroid Nodules and Goitre

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Thyroid nodules are very common, occurring in up to 50% of adults. Most are benign and do not cause symptoms. However, larger thyroid nodules and multinodular goitres can cause local mass effect symptoms, including difficulty swallowing (dysphagia), breathing discomfort, a sensation of pressure or a lump in the neck, and cosmetic concerns.

 

Some thyroid conditions can also cause excessive production of thyroid hormones (hyperthyroidism), resulting in symptoms such as palpitations, weight loss, tremor and heat intolerance. Treatment options depend on the underlying thyroid condition, size of the thyroid gland, symptoms and thyroid hormone function. These may include observation, medications, radioactive iodine, thyroid nodule ablation and thyroid surgery (thyroidectomy).
 

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Thyroid Artery Embolisation (TAE)

 

Thyroid Artery Embolisation (TAE) is a minimally invasive procedure performed by an Interventional Radiologist to reduce the blood supply to the thyroid gland by blocking blood flow to several of the four main arteries to the thyroid. During embolisation, a small catheter is navigated into the arteries supplying the thyroid gland, and tiny particles are injected to reduce or block blood flow.

This reduces the blood supply to the thyroid tissue, resulting in gradual shrinkage of the thyroid nodules and gland overall, improving the compressive symptoms.

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Thyroid Artery Embolization has been investigated internationally for the treatment of large thyroid nodules, multinodular goitre, and selected cases of hyperthyroidism. It may be particularly useful for patients with large-volume thyroid enlargement, including goitres extending into the chest (retrosternal goitre), where other treatments may be technically challenging or unfeasible. TAE is an emerging treatment, and the clinical evidence remains less established than for conventional thyroid surgery, radioactive iodine and thyroid nodule ablation. It is not currently considered a routine first-line treatment for most people.
 

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Procedure

 

1. A specialist Interventional Radiologist (IR) will first consult and examine you in the outpatient clinic to assess your suitability for thyroid artery embolisation. Your thyroid ultrasound, blood tests and other relevant imaging will be reviewed or requested as required. Your case may also be discussed with an endocrinologist or thyroid surgeon.

2. You will likely be prescribed, or need to continue, medications including beta-blocker in the weeks leading up to the procedure.

3. Thyroid Artery Embolisation is performed in an Interventional Radiology (IR) operating suite (angiography suite) under local anaesthetic and sedation.

4. A small catheter (tube) is inserted into an artery, typically through the groin or wrist, and navigated under X-ray guidance into the arteries supplying the thyroid gland. This is similar to other embolisation procedures or heart catheter procedures.

5. Contrast dye is injected to visualise the thyroid arteries and identify the blood supply to the thyroid tissue.

6. Tiny embolisation particles are injected through the catheter to reduce blood flow to the targeted thyroid tissue. The procedure may involve treating two or more thyroid arteries, depending on the underlying condition and individual anatomy.

7. Following the procedure, the catheter is removed and pressure is applied to the artery access site to prevent bleeding.

8. You will be monitored in hospital following the procedure. Most patients can expect to go home the same day (day-case procedure).

9. Most patients experience a degree of temporary neck swelling or low-grade fever following embolisation. You will need to continue your thyroid medications including beta-blocker for several weeks following TAE.

10. The thyroid gland gradually shrinks over the following months, and follow-up ultrasound and thyroid blood tests are performed to assess treatment response.

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Complications

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The overall risk of significant complications after thyroid embolisation (TAE) is low (<3%), but these may include:

 

• Temporary worsening of thyroid hormone levels and symptoms of over-active thyroid

• Long term hypothyroidism (under-active thyroid)

• Non-target embolisation including stroke

• Temporary voice change or nerve injury

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Specialist Expertise

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Interventional Radiologists (IRs) are uniquely specialty trained in both the advanced imaging (ultrasound) assessment of thyroid nodules and image-guided "pin-hole" procedures in the thyroid, including FNA biopsy. Interventional Radiologists (IRs) are also specialty trained in minimally invasive endovascular procedures, including angiography and embolisation, allowing small catheters and instruments to be navigated through the blood vessels under X-ray guidance to deliver precise treatment without major surgery. It was with this unique skillset that thyroid embolisation was first invented by Interventional Radiologists, building on established embolisation techniques used to treat conditions throughout the body, including the uterus, prostate, kidney, liver and lungs. 

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Interventional Radiologists (IRs) are qualified and credentialed to perform embolisation procedures in major public teaching (academic) hospitals including at the Alfred Hospital (Bayside Health) and Monash Health in Melbourne, Australia, as well as private hospital locations. Dr Matthew Lukies was the first to perform thyroid artery embolisation for goitre in Melbourne, Australia.

 

Dr Matthew Lukies

Matthew has a keen interest in minimally invasive thyroid procedures, including ablation and embolisation. He was fortunate to spend time training with Prof Wei-Che Lin (Radiologist) in Kaohsiung, Taiwan, a key centre that has been at the forefront of thyroid embolisation over the past decade. Matthew and colleagues consult patients weekly regarding thyroid nodules and goitre, and minimally invasive IR treatment options.

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Multidisciplinary Care

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It is important that you consider all suitable treatment options for thyroid nodules and goitre. These may include thyroid nodule radiofrequency ablation (RFA), thyroid surgery, radioactive iodine and medical management. Thyroid Artery Embolisation is not suitable for everyone and is generally considered in selected patients where conventional treatments are unsuitable or not preferred. After consultation with our Interventional Radiologist, your case may be discussed with or referred to an endocrinologist or thyroid surgeon to ensure that all appropriate treatment options have been considered.

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Preparation and Referral

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If you would like to consult with an Interventional Radiologist about Thyroid Artery Embolisation, please send a referral for consultation, including the following:

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• Thyroid ultrasound results.

• Thyroid blood test results, including TSH and thyroid hormone levels.

• Thyroid fine needle aspirate (FNA) results, if available.

• CT or MRI imaging of the thyroid and neck, particularly for large or substernal goitres.

• Records of consultations with endocrinologists, thyroid surgeons and other specialists.

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Your Interventional Radiologist will review your results and discuss whether thyroid artery embolisation, thyroid nodule ablation or another treatment option is most appropriate.

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Thyroid Artery Embolisation is an emerging treatment, and availability and suitability will depend on individual clinical circumstances.

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Thyroid Embolisation content by Dr Matthew Lukies.