Endocrine Abstracts

JOINT3941

Introduction: Endothoracic goiter can lead to mediastinal invasion and compression of vital structures: trachea, esophagus, and large vessels. Surgery is the first line treatment, yet in some cases may require sternotomy, increasing significantly morbidity and mortality. In elderly frail patients or those with severe comorbidities, surgery may be contraindicated due to high surgical risk. In such cases thyroid artery embolization (TAE) is presented as a safe and effective alternative.

Material and Methods: Since 2022, 15 patients (81.1% women, 80(71-91)) with symptomatic endothoracic goiter, not candidates for surgery due to high surgical risk underwent palliative TAE. Dysphagia was reported in 54.5%, dyspnea in 27.3% and both symptoms in 18.2%. Regardless of thyroid function, 33.3% of patients had previous hyperthyroidism. Deviation of the vascular bundle, esophagus and trachea was reported in 36.4% of the patients and 63.6% had tracheal stenosis. Initial calculated volume was 131±114 ml. During follow-up, all patients were assessed clinically, analytically, and radiologically.

Results: Median follow-up of was 10.5±5 months. Total volume significantly decreased over time, reducing from an initial 131±114 ml to 56±111 ml at 3 months and 72±85 ml at 12 months of follow-up. A progressive reduction was evident, with a 45% decrease from the initial volume at 3 months and a 59% reduction at 12 months. No patient showed a significative increase during follow up. All patients reported improvement of obstructive symptoms. Among patients who reported dysphagia or weight loss, follow-up showed an average weight gain of 3.5 ± 3.7 kg. Transient hyperthyroidism was reported in 81% with a median duration of 30 days but was not clinically significant. The peak mean FT4 level was 2.8 mg/dl (DS 1.6-3.9). Eventually, all patients with normal thyroid function normalized their values during follow-up. Among patients with pre-existing hyperthyroidism, hyperfunction was controlled in 3 out of 5 cases and no patient developed new onset hypothyroidism. Two major complications were recorded, possibly associated with the procedure (stroke with ad integrum recovery, bronchospasm).

Conclusion: In our series of patients, thyroid artery embolization (TAE) in symptomatic endothoracic goiter is an effective and safe procedure in patients who are not candidates for surgery, being a minimally invasive procedure with rapid recovery.