Authors
Lukyanov N.S., Lukyanov S.V., Kosovtsev E.V., Blikyan K.M., Sapronova N.G., Putilina A.M., Lyudmirskaya E.B.
The Rostov State Medical University, Rostov-on-Don
Abstract
Backgraund. Due to the anatomical and physiological features of the thyroid gland, surgery is accompanied by a high risk of bleeding. Intraoperative bleeding worsens the conditions of surgical access and can lead to traumatization of vital anatomical structures, which is fraught with the development of postoperative hypoparathyroidism and recurrent laryngeal nerve paresis. Bleeding in the early postoperative period creates a risk of compression hematoma formation, which can cause asphyxia. In order to minimize the risks of surgical treatment and prevent complications, methods of preoperative patient preparation have been actively developed in recent years.
Aims. A comprehensive assessment of the dynamics of thyroid gland volume and blood supply parameters following selective bilateral embolization of its arteries in patients with diffuse toxic goiter.
Materials and methods. A combined retrospective and prospective clinical study was conducted, involving patients who underwent thyroid artery embolization as a preparatory step prior to total thyroidectomy. Morphometric (volume, echostructure) and hemodynamic parameters (linear and volumetric blood flow velocity, peripheral resistance indices) were assessed using ultrasound Doppler ultrasonography preoperatively and within the first 48 hours post-embolization.
Results. Endovascular embolization resulted in a statistically significant and sequential reduction in thyroid parenchyma volume. A significant decrease in linear blood flow velocity was observed in all four main feeding arteries (superior and inferior thyroid arteries). The most pronounced hemodynamic and morphometric effect was noted in the early stages (first 24 hours) post-intervention.
Conclusions. The obtained results confirm the high efficacy and rationale for using selective thyroid artery embolization as a preparatory step before radical surgical treatment of diffuse toxic goiter. This method minimizes intraoperative risks, primarily by reducing organ blood supply intensity and decreasing its volume, which improves the visualization of fine anatomical structures and reduces the likelihood of their iatrogenic injury during thyroidectomy.
Keywords: diffuse toxic goiter, Graves’ disease, thyroid artery embolization, blood flow reduction, thyroid blood supply, thyroidectomy.
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