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Is Thyroid Arterial Embolization A Viable Treatment Option For Graves’ Disease?

Published October 20 2014

Arterial embolization involves cutting off the blood supply of a tumor, cyst, or organ.  Although there are a number of small clinical trials showing that thyroid arterial embolization can help people with Graves’ Disease, as well as those who have large goiters, most endocrinologists don’t bring this up as a treatment option.  And while thyroid arterial embolization doesn’t do anything to address the cause of the problem, it arguably is a better option for those who are leaning towards radioactive iodine.

So what is involved with thyroid arterial embolization?  As I mentioned in the opening paragraph, with arterial embolization, the blood supply to an organ is cut off. So in thyroid arterial embolization, the blood supply to the thyroid gland is cut off.  The downside is that this usually involves minor surgery, and of course there are always risks involved with surgery.  However, the upside is that unlike RAI or a thyroidectomy, most people who receive this procedure don’t become hypothyroid.  In addition, the thyroid antibodies also will frequently decrease.

Although the focus of this article is to discuss the benefits and risks of thyroid arterial embolization, this procedure has been successfully used to treat other conditions.  For example, uterine fibroid embolization (UFE) is another option for those women with fibroids who want to try avoiding surgery.  Although the goal should be to try to address the uterine fibroid naturally, in some cases the fibroid is very large, and conventional treatment methods might be the best option.  The problem is that a hysterectomy is commonly recommended for large uterine fibroids.  But in some cases, uterine fibroid embolization can be a safe and effective alternative to a hysterectomy (1) [1] (2) [2].

Who Should Consider Receiving Thyroid Arterial Embolization?

Many people with Graves’ Disease are told that radioactive iodine or thyroid surgery are the best options, and in some cases, the only options.  Of course my goal is to try to detect and then address the actual cause of the problem so that people don’t need to resort to RAI or surgery.  However, not everyone can have their health restored naturally, and some people who can benefit from natural treatment methods don’t want to consider following a natural treatment protocol.  Obviously someone can choose to take antithyroid medication for awhile and see if this helps to put their hyperthyroid condition into a state of remission.  But many times this doesn’t happen, and it’s not uncommon for people to experience negative symptoms while on the medication and/or an increase in the liver enzymes.  As a result, someone might want to consider receiving thyroid arterial embolization if they fall within one or more of the following categories:

1. They don’t want to follow a natural treatment protocol, but also don’t want to receive RAI or thyroid surgery.

2. They tried following a natural treatment protocol but it didn’t help to put their condition into remission.

3. They took antithyroid medication for 12 to 18 months and it failed to put their condition into remission.

4. They are unable to take antithyroid medication due to either an adverse reaction and/or an elevation of the liver enzymes.

This Procedure Might Also Benefit People With Large Goiters

Regardless of whether someone has Graves’ Disease or not, if someone has a large goiter then they might benefit from thyroid arterial embolization.  Initially I would recommend taking the natural approach, as when I was diagnosed with Graves’ Disease I had a goiter, and this eventually resolved.  However, I definitely wouldn’t have classified my goiter as being large, and some people with larger goiters might not be able to shrink them naturally.  One study involving thyroid arterial embolization showed that the goiter size reduced approximately 32% of its original volume (3) [3].

What Does The Research Show?

There are numerous research studies which show the benefits of thyroid arterial embolization.  One study showed that 14 of 22 patients who received this procedure became euthyroid (4) [4].  The patients were followed for a median time of 27 months, and at the end of this follow-up period they remained euthyroid, and the size of the thyroid gland had decreased by one third to one half of its original volume.  It was concluded that this procedure is an effective, minimally invasive, and safe method for the treatment of Graves’ Disease patients who cannot, or choose not to, accept current therapies.  Another study involving 37 patients with Graves’ Disease who received thyroid arterial embolization showed that the thyroid hormones and TSH gradually resumed to normal range while the TSH receptor antibodies decreased significantly (5) [5].  A case study involving a 35-year old woman with a history of thyrotoxic crises showed that thyroid hormone levels returned to normal two months after embolization and remained normal at three years (6) [6].

What Are The Benefits of Thyroid Arterial Embolization?

Let’s go ahead and summarize some of the benefits of this treatment procedure.  Probably the main benefit is that it isn’t as invasive as radioactive iodine or thyroid surgery.  And unlike both RAI and thyroid surgery, thyroid arterial embolization has the potential to make someone euthyroid, and not hypothyroid.  In addition, it somehow might modulate the immune system, resulting in a decrease in thyroid antibodies.

What Are The Risks of Thyroid Arterial Embolization?

What are some of the risks associated with this procedure?  First of all, even though it isn’t as invasive as RAI or thyroid surgery, it still involves minor surgery.  In addition, most of the clinical trials have been small, and there aren’t any long term studies I’m aware of which show how someone will do in 10+ years after receiving this procedure.  Although there are multiple smaller studies, it would be nice if they put together some larger clinical trials, and show some statistics from people who have received this procedure ten years ago or longer.  Also, caution might need to be used when arterial embolization is considered for those with thyroid eye disease (7) [7].

Finally, thyroid arterial embolization doesn’t do anything to address the cause of the problem.  Remember that this procedure involves cutting off the blood supply to your thyroid gland, which in my opinion shouldn’t be the first treatment option.  The reason why this method has been so successful is because it involves necrosis of the thyroid cells.  In other words, cutting off the blood supply will kill some of the cells of the thyroid gland, although it doesn’t cause as much damage as RAI, which is why people typically become euthyroid rather than hypothyroid.  Obviously I would recommend following a natural treatment protocol first rather than cause any type of damage to the thyroid gland.  And if someone doesn’t respond well to natural treatment methods then I might recommend for them to try something such as low dose naltrexone (LDN) before trying thyroid arterial embolization, although one disadvantage of LDN is that even if it works (which isn’t always the case), the person will need to continue taking it on a regular basis.  For more information on LDN you can check out my blog post entitled “Can Low Dose Naltrexone Cure Graves’ Disease and Hashimoto’s Thyroiditis? [8]

In summary, thyroid arterial embolization is a procedure which involves cutting off the blood supply of the thyroid gland.  Although I would recommend for most people to follow a natural treatment protocol before trying this procedure, thyroid arterial embolization might be a better option than RAI or thyroid surgery.  In addition to thyroid arterial embolization not being as invasive as RAI or thyroid surgery, it also can make someone euthyroid, and not hypothyroid, while possibly lowering the thyroid antibodies.  However, this procedure isn’t doing anything to address the cause of the problem, involves necrosis of the thyroid cells, and there is a lack of long term studies.