Embolization of Thyroid Arteries as a Bridge Therapy Before Thyroidectomy in a Patient With Thyrotoxicosis: Case...

Thyroid artery embolization (TAE) is a minimally invasive technique that induces selective ischemic necrosis of the thyroid parenchyma, thereby reducing thyroid hormone synthesis with few associated complications. Successful cases of TAE as a bridge therapy before total thyroidectomy in patients with refractory thyrotoxicosis are rare. We present the case of a 36-year-old man with a history of Graves' disease and poor adherence to medical therapy who presented with clinical features of thyrotoxicosis. On physical examination, he exhibited active moderate-to-severe orbitopathy (EUGOGO classification; clinical activity score 5/7) and a grade III goiter, reflecting advanced and poorly controlled disease. Paraclinical findings revealed markedly elevated free T4 levels and suppressed TSH. The diagnosis of uncontrolled hyperthyroidism was made, with a Burch-Wartofsky score of 40 points, indicating an impending thyroid storm. Medical therapy at maximally tolerated doses did not result in a complete clinical response; therefore, a total thyroidectomy was planned, preceded by therapeutic plasma exchange (TPE). Due to intolerance to TPE, TAE was performed as a bridge therapy, followed by total thyroidectomy without complications. The patient was discharged with a resolution of symptoms and progressive normalization of thyroid hormone levels. TAE may represent a valuable bridging therapy before total thyroidectomy in selected patients with severe thyrotoxicosis due to Graves' disease who are refractory to or unsuitable for conventional therapies.