Complete pathologic necrosis of a thyroid neoplasm following pressure-enabled thyroid artery embolization

Thyroid nodules are increasingly detected with advanced imaging. Although most are benign, accurate preoperative risk stratification remains essential. Fine-needle aspiration is central to evaluation, yet Bethesda III nodules remain challenging because of the variable malignancy risk. Thyroid carcinoma generally has a favorable prognosis, but certain molecular subtypes are associated with higher mortality. Therefore, surgical resection remains the standard treatment for indeterminate and malignant thyroid tumors. However, the thyroid's rich vascular supply, along with comorbidities and factors such as age and mediastinal extension, can increase operative risk. Preoperative transarterial embolization has emerged as an adjunct to reduce tumor vascularity and improve surgical outcomes. We report a case of a 72-year-old African American male with multiple comorbidities who presented with an indeterminate thyroid neoplasm harboring a TERT promoter pathogenic variant, indicating high malignancy risk. The patient underwent pressure-enabled thyroid artery embolization followed by thyroidectomy 72 hours postembolization. Lesion histopathology showed nuclear debris and ghost cells consistent with complete pathologic necrosis. This case supports the feasibility of embolization as an adjunct in the multidisciplinary management of high-risk patients and provides a foundational basis to further study embolotherapy in unresectable tumors or nonsurgical candidates.