Effect of Preoperative Transarterial Embolization on Surgical Blood Loss in Thyroidectomy for Large Graves' Disease.

Abstract

Thyroidectomy for Graves' disease (GD) is associated with an increased risk of intraoperative bleeding, particularly in patients with enlarged and hypervascular thyroid glands. This retrospective cohort study evaluated factors associated with intraoperative blood loss and examined the association between preoperative transarterial embolization (TAE) and surgical outcomes. A total of 199 patients with GD who underwent thyroidectomy between 2015 and 2024 were analyzed and stratified by excised thyroid weight (< 100 g, 100-200 g, and > 200 g). Preoperative TAE was selectively performed in patients with large goiters beginning in 2021. Multivariate regression analysis identified thyroid weight (95% confidence interval [CI] 0.58-1.30, p < 0.001), operative time (95% CI 0.04-1.05, p = 0.035), and duration from disease onset to surgery (95% CI 2.50-17.72, p = 0.010) as independent predictors of increased blood loss. In patients with thyroid glands weighing > 200 g, TAE was associated with significantly lower intraoperative blood loss compared with historical controls (median 95 vs. 350 mL, p = 0.012), without an increase in postoperative complications. No significant benefit was observed in patients with glands weighing 100-200 g. Larger thyroid gland size is associated with increased intraoperative blood loss for GD, and selective preoperative TAE may reduce bleeding in patients with markedly enlarged glands.