Graves’ disease, an autoimmune disorder characterized by hyperthyroidism, presents a complex challenge for patients and clinicians alike. While conventional treatments such as medications and radioactive iodine therapy are effective for many individuals, some may experience refractory symptoms or adverse effects. Thyroid artery embolization (TAE) has emerged as a promising alternative for managing Graves’ disease.
Understanding Graves' Disease
Graves’ disease results from the production of autoantibodies that stimulate the thyroid gland to produce excessive amounts of thyroid hormone. This leads to symptoms such as palpitations, weight loss, heat intolerance, and anxiety. While medication and radioactive iodine therapy are commonly used to manage Graves’ disease, some patients may experience inadequate symptom control or develop complications.1
Graves' Disease Treatment Options
Antithyroid Medications
Antithyroid medications, such as methimazole and propylthiouracil, are commonly used as first-line therapy for Graves’ disease. These medications work by inhibiting the production of thyroid hormones. They can effectively control hyperthyroidism in many patients, with symptom improvement typically seen within weeks of initiating treatment. However, antithyroid medications may not induce long-term remission, and relapse rates can be high after discontinuation. Propylthiouracil is associated with a risk of liver toxicity and is generally reserved for specific cases.2
Radioactive Iodine Therapy (RAI)
Radioactive iodine therapy involves the oral administration of a radioactive iodine-131 pill, which selectively accumulates in the thyroid gland and destroys thyroid tissue. RAI is highly effective in achieving long-term control of hyperthyroidism, with remission rates ranging from 60% to 90%. However, this is a radiation dose that is not exact and as such it carries a risk of permanent hypothyroidism due to complete thyroid tissue destruction, necessitating lifelong thyroid hormone replacement therapy. Additionally, RAI may exacerbate thyroid eye disease in some patients.3
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Thyroidectomy
Thyroidectomy, or surgical removal of part or all of the thyroid gland, is typically reserved for patients who cannot tolerate or fail to respond to antithyroid medications or RAI, as well as those with large goiters or compressive symptoms. Thyroidectomy provides definitive treatment for Graves’ disease and can rapidly normalize thyroid hormone levels. However, it carries risks of surgical complications such as bleeding, infection, and damage to adjacent structures, as well as the potential for postoperative hypoparathyroidism and recurrent laryngeal nerve injury affecting the voice.4
Emerging Interventions
Emerging interventions such as thyroid artery embolization and biological therapies offer promising alternatives for select patients. Thyroid artery embolization is a non-surgical treatment that involves the selective occlusion of a few of the thyroid arteries to reduce blood flow to some of the thyroid gland. Studies suggest that thyroid artery embolization can achieve significant reductions in thyroid hormone levels and symptom improvement in some patients.5 Biological therapies, such as rituximab and TSH receptor antibodies, target specific components of the immune system involved in the pathogenesis of Graves’ disease and are being investigated as potential treatments.6
Thyroid Artery Embolization for Graves’ Disease
Thyroid artery embolization is a non-surgical option that involves the selective occlusion of 2-3 thyroid arteries supplying blood to the hyperactive thyroid gland. The embolization procedure is already performed and successful for tumors, cancers, pain, bleeding, and organ volume reduction involving many different body parts. Our doctor is an embolization expert that has performed this procedure for many organs including the lung, prostate, uterus, thyroid, liver, kidney, bowel, stomach and much more!
During the procedure, our doctor inserts a tiny IV like catheter into the wrist or groin. This tiny catheter is then advanced into the arteries supplying the thyroid gland under a special x-ray machine. Once the catheter is in position, small particles are injected to block blood flow to some of the thyroid gland tissue, thereby reducing its activity and hormone production. Read more about the TAE procedure here.
Advantages of Thyroid Artery Embolization:
- Minimally invasive: TAE is a minimally invasive procedure that can be performed under local anesthesia. It does not require surgery or general anesthesia, reducing the risk of complications associated with invasive interventions.
- Targeted treatment: TAE selectively targets the thyroid arteries, allowing for precise modulation of blood flow to the hyperactive gland. This targeted approach minimizes damage to surrounding tissues and organs, potentially reducing the risk of complications such as hypothyroidism or damage to the parathyroid glands.
- Rapid symptom relief: Some patients experience rapid relief of symptoms following TAE. By reducing thyroid hormone production, TAE can alleviate the manifestations of hyperthyroidism and improve the patient’s quality of life.7
Thyroid Artery Embolization vs. Traditional Grave’s Treatments
1. Minimally Invasive Nature
- TAE: Thyroid artery embolization is a minimally invasive procedure that does not require surgery or general anesthesia. It can often be performed on an outpatient basis, allowing for a quicker recovery and reduced hospital stay. There are incisions or sutures.
- Traditional Treatments: Conventional treatments for Graves’ disease, such as antithyroid medications, may require long-term medication. Radiation pill requires hospitalization and has high risk of hormone replacement therapy for life. Thyroid removal is invasive and requires a long recovery and lifelong hormone replacement. These interventions carry risks of adverse effects and may not be suitable for all patients.
2. Preservation of Thyroid Function:
- TAE: Thyroid artery embolization selectively reduces blood flow to the hyperactive thyroid gland without ablating or destroying the gland itself. This preservation of thyroid tissue may reduce the risk of hypothyroidism, a common complication of other treatment modalities.
- Traditional Treatments: Radioactive iodine therapy aims to destroy the entire thyroid tissue to reduce hormone production, often leading to permanent hypothyroidism. Thyroidectomy likewise is the removal of the entire gland requiring lifelong hormone therapy. Medications can control symptoms; however, they do not address the underlying thyroid dysfunction and may require long-term use.
Thyroid artery embolization represents a promising alternative for the management of Graves’ disease, offering a minimally invasive, targeted approach to reducing thyroid hormone production. While further research is needed to establish its long-term efficacy and safety, current studies suggest that TAE may provide rapid symptom relief and preserve thyroid function compared to traditional treatments. As with any medical intervention, the decision to undergo thyroid artery embolization should be made in consultation with a multidisciplinary team, considering the individual patient’s clinical status, preferences, and treatment goals.
Why California Thyroid Center?
Our physician is one of only a few specialists with a background in both thyroid RFA ablation and the embolization technique. He will evaluate you and decide which treatment option will suit you best. Sometimes a combination approach is necessary to save the thyroid gland.
Our center specializes in embolizations, and our staff is uniquely trained to care for these types of procedures, from the pre-op to the post-op period. Our specialist performs embolization for not only the thyroid but also in other higher risk and complex organs, such as the uterus, kidney, liver, prostate, lung and others. Patients are often surprised how quick and simple the TAE procedure was for them, but this comes at the experience of our specialist who performs a variety of complex embolizations safely. This diversity of experience has resulted in our specialist to treat complex cases safely and effectively.
Our specialist continually keeps up with the research to make sure that he brings the best and newest technology to our center. We are also always collecting feedback from patients and modifying how we provide care so that patients have the best level of experience.
Contact Us Today
Request an appointment to meet with our RFA specialist who will review your imaging, labs and history to determine if you are a good candidate for the procedure, and the outcomes you can expect. Each person is an individual and should discuss the potential risks and benefits of thyroid RFA with our doctor to decide if this is the best option.
Appointments are available via an online video telehealth platform or in person in Los Angeles, California. Why should you choose us? Read here.
- Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-1421.
- Cooper DS. Antithyroid Drugs. N Engl J Med. 2005;352(9):905-917.
- Metso S, Jaatinen P, Huhtala H, et al. Long-term follow-up study of radioiodine treatment of hyperthyroidism. Clin Endocrinol (Oxf). 2004;61(5):641-648.
- Stålberg P, Svensson A, Hessman O, Åkerström G, Hellman P. Surgical Treatment of Graves’ Disease: Evidence-Based Approach. World J Surg. 2008;32(7):1269-1277.
- Zhao L, Teng D, Shi X, et al. The effect and safety of embolization of thyroid arteries for the treatment of hyperthyroidism: a meta-analysis. Int J Clin Exp Med. 2015;8(7):11380-11387.
- El Fassi D, Nielsen CH, Hasselbalch HC, Hegedüs L. Treatment-resistant severe, active Graves’ ophthalmopathy successfully treated with B lymphocyte depletion. Thyroid. 2006;16(7):709-710.
- Zhao L, Teng D, Shi X, et al. The effect and safety of embolization of thyroid arteries for the treatment of hyperthyroidism: a meta-analysis. Int J Clin Exp Med. 2015;8(7):11380-11387.
The above information explains what is involved and the possible risks. It is not meant to be a substitute for informed discussion between you and your doctor but can act as a starting point for such a discussion.
