Thyroid Arterial Embolization for the Management of Benign and Malignant Thyroid Disease: A Systematic Review

Abstract

Objective: Thyroid arterial embolization (TAE) is a minimally invasive procedure that reduces blood flow to the thyroid gland by injecting particles into the superior and/or inferior thyroid artery. It has been sporadically used for goiter, Graves’ disease, thyrotoxicosis, and thyroid cancers, but no reviews have assessed its safety and efficacy. Methods: Databases were searched until January 2024. English-language studies on TAE were included. Studies using TAE for arterial aneurysms or lacking full text were excluded. No meta-analyses were performed. Results: Among 1203 retrieved articles, 24 studies met inclusion criteria: TAE was used for goiter (8 studies), Graves’ disease (8), thyroid malignancy (5), and thyrotoxicosis (4). The primary outcome was safety and efficacy. Limited evidence suggested benefits, including goiter size reduction and symptom relief with minimal complications like neck pain and hematoma. In Graves’ disease, TAE induced hormonal and immunologic changes, normalizing thyroid function in some patients. In thyroid cancer, it alleviated symptoms and facilitated safer surgery. However, serious risks, including nontarget embolization and mortality, require caution. Conclusion: This review presents an overview of the literature regarding safety and efficacy of TAE. The lack of robust data, significant risk of serious complications (including nontarget embolization and mortality), and absence of a standardized, safe protocol preclude recommending TAE as a routine treatment option. Given the high efficacy and lower complication rates of current established therapies, TAE should only be considered in exceptional circumstances, when standard treatments have failed or are contraindicated, and then only at specialized centers with extensive embolization expertise.