Exacerbation of thyroid associated ophthalmopathy after arterial embolization therapy in a patient with Graves' disease.
A novel treatment approach to Graves' disease (GD), embolization of the thyroid gland arteries, is evaluated with respect to its indications and adverse effects. We describe an exacerbation of thyroid associated ophthalmopathy (TAO) following thyroid artery embolization in a woman with GD and mild stable TAO (NOSPECS classification, class I grade a). A 45-year-old woman with GD and inactive TAO, in whom thyroid function was stable following blockade of hormone release combined with replacement therapy, underwent embolization of three thyroid arteries. Initially, there were neither adverse effects nor complications; however, the patient developed severe TAO (NOSPECS classification, class IV grade b) 3 months after the arterial embolization. Steroid pulse treatments followed by total thyroidectomy resulted in improvement of the eye signs and symptoms. The clinical course and the serial changes of the thyroglobulin and thyroglobulin-antibody titers suggested that the destruction of thyroid follicles, induced by the arterial embolization, triggered the exacerbation of her TAO. Our experience argues for the use of caution when arterial embolization is considered for GD patients with even the mildest TAO (NOSPECS classification, class I).
Hiraiwa
Tetsuya
T
First Department of Medicine, Osaka Medical College, Takatsuki City, Osaka 569-8686, Japan. in1149@poh.osaka-med.ac.jp
Imagawa
Akihisa
A
Yamamoto
Kazuhiro
K
Arimoto
Hiroshi
H
Arishima
Takeshi
T
Ito
Mitsuru
M
Nakamura
Yasushi
Y
Matsuzuka
Fumio
F
Miyauchi
Akira
A
Sugasawa
Jun
J
Ikeda
Tsunehiko
T
Narumi
Yoshifumi
Y
Hanafusa
Toshiaki
T
D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000628:therapy*; D049970:Graves Ophthalmopathy / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis