Thyroid Artery Embolization vs Ablation
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University of Miami, Florida
Interventional Radiologist Alan Alper Sag, MD, from the University of Miami in Florida, presented a discussion at ISET 2025 that compared thyroid artery embolization (TAE) and radiofrequency ablation (RFA) as minimally invasive alternatives to traditional surgical and medical treatments for thyroid disorders. He explored the indications, advantages, and limitations of each approach, emphasizing how these modalities can complement rather than compete with one another. Selection depends on anatomy, vascular supply, and patient-specific factors.
The first topic discussed was goiter and a review of the different types and treatment approaches. Retrosternal benign goiter is best suited for TAE with glue and radiopaque agents (TAEGR). Cervical benign goiter with hypertrophic arteries can use either RFA or TAEGR, depending on arterial supply and response. For cervical benign nodules without hypertrophic arteries, RFA is preferred due to its precision and lower vascular involvement. TAEGR is preferred for large, hypervascular goiters and patients requiring anticoagulation-friendly approaches, while RFA is ideal for focal nodules and office-based procedures.
Dr. Sag then discussed deciding how to choose between RFA and TAEGR. RFA is favored in patients with renal insufficiency (avoids contrast use); outpatient settings (simpler setup without angiography); and solitary hyperfunctioning nodules where focal ablation is needed. TAEGR is favored in patients with large thyroid volumes (>30 mL), where embolization can achieve significant shrinkage; patients with pacemakers (avoids electrical interference from RFA); and patients on anticoagulation (TAEGR can be performed via a radial approach). A combined approach of TAEGR + RFA is best in complex cases where embolization reduces vascularity before RFA for better efficacy.
Reviewing the technical considerations for embolization and ablation, Dr Sag discussed the embolization and RFA approaches. With an embolization approach, radial access is preferred in anticoagulated patients. The microcatheter and embolic choice includes Histoacryl® + Lipiodol®, polyvinyl alcohol, and papaverine. Cone beam computed tomography is used for precise targeting. With an RFA approach, monopolar or bipolar RFA devices are used; careful energy titration is needed to avoid nerve injury; and the clinician needs to consider sedation vs. local anesthesia considerations.
Dr Sag emphasized that post-procedure follow-up is essential, as transient thyroid hormone fluctuations can occur, requiring temporary beta-blocker therapy or endocrine management. Minimal discomfort can be managed with acetaminophen + ibuprofen). Transient elevation in free T4 levels is expected at days 7 and 30, leading to temporary TSH suppression. Metoprolol can be considered for palpitations, but should be avoided in patients with asthma, bradycardia (<60 bpm), or decompensated heart failure.
