Preoperative thyroid artery embolization in thyroidectomy patients with big goiter (III-V degree) and diffuse toxic goiter (literary review)

Introduction. Thyroid surgery is a technically complex type of surgical intervention, which is associated with the close topographic relationship of the thyroid gland with the vital anatomical structures of the human neck.

Objective: to analyze the results of published scientific studies on two-stage surgical treatment of thyroid gland in order to determine an effective, safe method for performing selective embolization of thyroid arteries (SETA) before thyroidectomy. Evaluate methods, clinical outcomes, and complications of SETA as a first stage of thyroidectomy in patients with large goiter (grades III–V) and diffuse toxic goiter (DTG). Improve surgical outcomes of thyroidectomy.

Methods. A total of scientific publications were analyzed, including domestic and 3 foreign ones. Methods and results of hybrid interventions on the thyroid gland performed as preparation for thyroidectomy were analyzed.

Results. Analysis of publications showed that thyroidectomy in this group of patients is associated with a high risk of bleeding, which increases the risk of injury to vital anatomical structures such as laryngeal nerves, esophagus, trachea, and parathyroid glands. SETA, as the first stage of surgical treatment for large goiters and DTG, has proven to be a promising, reproducible, safe, and effective way to prevent intraoperative hemorrhage. Additionally, performance of SETA carries risks of embolization of non-target vessels, including those of the brain. SETА reduces the blood supply to the thyroid gland, while venous outflow of blood remains unrestricted – this creates a potential risk of worsening thyrotoxicosis, which may be especially important in elderly people with coronary heart disease or severe arrhythmia.

Conclusions. Surgical treatment of patients with large grade III-V goiters is technically complex due to the high risk of bleeding caused by intense vascularization of the thyroid gland, leading to increased risk of damage to adjacent structures. SETA, as the first stage of surgical intervention, has established itself as a promising, effective, and safe method for preparing for thyroidectomy. Despite its high efficacy, the technique is associated with risks of worsening symptoms of thyrotoxicosis and possible embolization of non-target vessels. Therefore, it is necessary to define a clear time interval between stages of hybrid intervention, identify embolic materials suitable for performing SETA that minimize adverse events, and ensure safe performance of thyroidectomy.

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