Breakthrough Minimally Invasive Procedure Cures Rare Thyroid Disorder Without Scars
The patient, a professor at a university, had been having trouble breathing when in a recumbent position, as well as palpable neck swelling. Although retrosternal goiters typically present in elderly individuals, predominantly women over 50, this case was exceptional due to the patient's young age and the remarkable extent of the goiter's growth, reaching as far as the aortic arch. The cause of multinodular goiters in younger women, may arise secondary to iodine deficiency, hereditary goiter syndromes, or prolonged stimulation by thyroid-stimulating hormone (TSH), although we couldn't establish cause in this patient.
The case was handled by interventional radiology team comprising Dr. Dheeraj Shyam, Lead Consultant – Interventional Radiology, and Dr. Madhushree, Specialist – Interventional Radiology, of Aster Whitefield Hospital using a minimally invasive procedure- Thyroid artery embolisation.
A Preliminary CT angiogram and an ultrasound was done. It revealed that the enlarged multinodular thyroid was deriving blood supply from two pairs of thyroid arteries namely inferior and superior thyroid arteries on either sides. In this case the predominant arterial supply of the goitre was from right inferior thyroid artery. The interventional radiology team performed a minimally invasive procedure called thyroid artery embolisation. The procedure significantly reduced the size of the goiter overtime alleviating the patient's symptoms. Real-time imaging was employed, and three out of four arteries were occluded using medically safe particles (PVA particles), effectively cutting off the blood supply thus causing the goiter to shrink. RFA was a reinforcement strategy for one of the small nodule reported as Bethesda III, which again was a minimally invasive method.
'Thyroid artery embolization' is a precise and targeted procedure, beneficial for patients with large multinodular goitre and retrosternal goiters who are either unsuitable for surgery or prefer to avoid it.
In this case, the dominant arterial supply from the right inferior thyroid artery allowed us to safely perform embolisation using polyvinyl alcohol particles. This significantly reduced thyroid vascularity and size. In India, thyroid artery embolization (TAE) and radiofrequency ablation (RFA) for benign thyroid conditions, such as retrosternal goitre, are not yet widely available and remain limited to specialized tertiary care centers, said Dr. Dheeraj Shyam, Lead Consultant – Interventional Radiology at Aster Whitefield Hospital.
Careful planning was essential due to the proximity of the goitre to the aortic arch and mediastinal structures. The use of real-time ultrasound and fluroscopy guidance helped us precisely target the artery and nodule. With embolization and RFA, we achieved optimal volume reduction and symptom relief, while sparing the patient the risks of open neck surgery,' said Dr. Madhushree, Specialist Interventional radiologist, Aster Whitefield Hospital.
The patient responded well, reporting major relief in breathing within days. A follow-up scan after four weeks revealed the thyroid was smaller and less vascular. With no complications and very little stay in hospital, she returned to normal life shortly with few follow-ups scheduled to check on her recovery.
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