Endocrine Abstracts

Background: Although hyperthyroidism has many treatment options, hyperthyroidism is difficult to control in some patients. Hyperthyroidism has three main treatment options: antithyroid drugs, radioactive iodine therapy and surgical treatment. However, in some cases none of these treatments can be used. However, there are some patients who failed to respond to radioactive iodine therapy, patients who choose not to receive any one of the options, and others who are poor surgical candidates. Thyroid arterial embolization can be used for the treatment of Graves’ disease and other thyroid conditions requiring thyroid ablation. We describe the case of a patient with a large multinodular goiter that was with thyroid arterial embolization.

Case: Fifty six years old man has admitted to our hospital complaints of fatigue, dyspnea, growing cervical mass and swallowing difficulty. When the patient’s anamnesis was taken, it was learned that 20 years ago, the patient had subtotal thyroidectomy due to a nodular goiter. Patient who had not been followed for a long time, because of the current complaints increased in the last 2–3 months. On physical examination he presented a large, firm multinodular goiter that occupied the entire anterior cervical area. At admission, laboratory tests revealed normal sT4: 1.17 ng/dl (Normal Range: 0.89–1.37) and sT3: 2.45 pg/ml (Normal Range: 2.25–3.85), and decreased TSH: 0.017 μIU/mL (Normal Range: 0.47–3.41) levels. On ultrasound, a large goiter was visualized with multiple nodules of different sizes in both lobes. Thyroid scintigraphy showed irregular uptake with a large thyroid gland. Fine-needle aspiration biopsies performed in nodules were reported to be negative for malignancy. On neck computed tomography (CT) scan, the thyroid gland extended to the mediastinum and compressed the trachea. The patient was offered surgery because of symptoms of compression and extension of the gland to the mediastinum. Because the patient did not accept the operation, it was decided to thyroid arterial embolization to the patient. After embolization, no fever developed but the patient complained of mild anterior neck pain that regressed after therapy with standard anti-inflammatory treatment. At 30 days after embolization, thyroid hormone levels normalized and the thyroid ultrasound can showed that the thyroid gland had shrunk. The patient’s complaints have improved substantially.

Conclusion: Thyroid embolization may be the treatment of choice in large multinodular goiter where the surgery is not accepted or the surgery is contraindicated.