Juan C Camacho, Steven P Hodak, Alexander Lam, Howard A Riina, Richard H Marshall, Chelsey K Baldwin Teschner, Kepal N Patel
TAE is a safe, effective, and durable option for selected patients with large symptomatic benign nodules and goiters, with additional roles in hyperthyroidism and as a surgical adjunct. Further studies are needed to standardize technique and define its role relative to other therapies.
OBJECTIVES: To review the current evidence regarding thyroid artery embolization (TAE) for the management of benign and select malignant thyroid diseases and to present expert consensus recommendations from the North American Society for Interventional Thyroidology (NASIT) on patient selection, indications, technical considerations, safety, clinical outcomes, and the role of TAE in contemporary thyroid disease management.
METHODS: A multidisciplinary consensus was developed through literature review and expert input addressing indications, technique, outcomes, and controversies, including comparisons with surgery, thermal ablation and radioactive iodine therapy.
RESULTS: TAE is effective for large-volume disease (>30 mL) and substernal extension, achieving 32-73% volume reduction at 6 months with improvement in symptoms and cosmesis. In hyperthyroidism (Graves' disease and toxic multinodular goiter), euthyroid rates exceed 70% with durability up to 50 months. Preoperative use reduces operative time and blood loss. Complications are typically mild and self-limited; serious events are rare. Advances include pressure-enabled embolization and collateral flow management.
CONCLUSIONS: TAE is a safe, effective, and durable option for selected patients with large symptomatic benign nodules and goiters, with additional roles in hyperthyroidism and as a surgical adjunct. Further studies are needed to standardize technique and define its role relative to other therapies.