134 Endovascular Embolization for Treatment of Benign Thyroid Goiter

INTRODUCTION: Benign thyroid goiters can grow to substantial size and cause clinical symptoms related to mass effect on critical mediastinal structures. Surgery can carry significant morbidity with large lesions, which can often extend into the substernal or retrosternal space. Endovascular treatment is a minimally invasive alternative strategy. METHODS: We reviewed the EMR of 9 patients with bilateral nodular thyroid goiter referred for neurosurgical endovascular embolization at NYU Langone Health between 2023-2024. All patients underwent prior FNA biopsy, baseline thyroid function testing, neck ultrasound and/or CT neck with contrast. Catheter angiography was performed through right femoral arterial access. Embolic material using 45-355 um polyvinyl alcohol (PVA) spheres or embospheres (tris-arcyl polymer) were infused in target vessels until distal stagnation of contrast. Patients were monitored for at least 24 hours post-procedurally. RESULTS: 9/9 patients (100%) were female, aged 37-80. All patients carried a diagnosis of FNA-negative, benign multiple nodular goiter (MNG). 8/9 goiters were located in the substernal space, 5/9 goiters extended into the intrathoracic space. The most common clinical symptoms were dysphagia (3/9) and globus sensation (3/9). Unilateral superior/inferior thyroid arteries were both embolized in 4/9 patients, and either the superior or inferior thyroid artery embolized in isolation in 5/9 patients. Follow-up imaging (either CT or US) was available for 5/9 patients. Of these, 4/5 patients demonstrated substantial reduction in size and 1/5 demonstrated moderate reduction. All 5 patients reported improvement in compression-related symptomology. 2/5 patients demonstrated impressive size reduction of contralateral goiter secondary to intrathyroidal collateralization. One patient suffered from particle reflux into intracranial circulation with small ipsilateral MCA/ACA watershed infarcts and made complete neurologic recovery by 4-month follow-up. CONCLUSIONS: Endovascular embolization may be an effective treatment strategy for large benign thyroid goiter with an acceptable safety profile.