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Oct 22

Written by: Elaine Moore
10/22/2008 9:36 PM 

I recently heard from a patient who had arterial embolization for Graves’ disease performed in China by Dr. Xhou earlier this month. In 2007, Dr. Xhou published a study in which  twenty-eight patients with hyperthyroidism caused by Graves' disease were enrolled to undergo thyroid arterial embolization and followed up for 12-22 months.

In the study, twenty-two patients had three thyroid arteries embolized and six patients two arteries. Serum thyroid hormone, thyroid-stimulating hormone (TSH), and autoimmune function were tested before and after embolization in all patients.

RESULTS: Of 28 patients, 22 (78.6%) became euthyroid, five improved (17.8%), and one had temporary improvement followed by recurrence (3.6%). No serious complications occurred. Compared with the pre-embolization values, serum concentrations of thyroid hormone increased temporarily on day 3 post-embolization, dropped substantially after 1 and 2 months, and returned to nearly normal at 6 and 12 months post-embolization.

TSH dropped on day 3, increased after 1 and 2 months, and returned to normal after 6 and 12 months. Thyroid antibodies TGAb and TPOAb declined on day 3 to normal range, rose after 1 month, dropped to normal again after 2 months, and were slightly increased at 6 and 12 months follow-up. Unfortunately, TSI levels weren't measured.

The patient I heard from is the first American to have had this procedure done. She reported that Dr. Xhou is willing to train other physicians in this procedure, which is currently not approved for use in the United States. She is also willing to answer questions from other patients.

Tags:

6 comment(s) so far...

Re: Arterial Embolization for Graves' Disease

Elaine, this is fascinating. It's too bad that they didn't measure TSI and/or TRAb as a baseline with follow-up. I assume when they say in Months 6-12 that the slight increases in TPOAb didn't exceed their baseline TPOAb. That wasn't clear to me. In any event, I'm really curious about this and hope there will be further follow-ups on how these patients do over time. The most remarkable things is TSH returning to normal after 6-12 months. Can I assume that all of them were off other treatments post-op (ATDs, etc.)?

By Valerie on   10/27/2008 9:21 AM

Re: Arterial Embolization for Graves' Disease

Hi Valerie,
The patients were off all other treatments in this study.
The lady who had the procedure done in China gave me some really good information and I plan to write an article on the topic later this week. She said Dr. Xhou would really like to come to the U.S. and teach others how to do this procedure. In her case, she couldn't tolerate meds and her hyperthyroidism was too severe to consider more aggressive therapies. She said the procedure's value is in people like her who can't use meds to achieve remission. Her email is vstella@netscape.net and she's willing to tell her story to others with an interest.
Total cost of the procedure and hospital stay was $7,000 and she's still working with her insurance company to see what part would be covered.

I agree that TSI or TRAb are needed to see if there's sufficient reduction to offset the risk of developing TED. It would be good too to see long-term effects. I'll contact Dr. Xhou to see what follow-ups there have been since the study. You might want to interview the patient for an AHSTA column.

By emoore on   10/27/2008 9:30 AM

Re: Arterial Embolization for Graves' Disease

Hi Bredia,

I'm not a doctor. I'm a medical technologist and I should have paid more attention to what I was having done when I consented to having RAI. That really was the worst decision I've ever made.
You're absolutely right that it makes no sense to destroy a perfectly good organ, especially when RAI worsens the immune system problem. Keep us posted with your outcome. It sounds like you have a great handle on things. Best to you, Elaine

By emoore on   11/3/2008 2:58 PM

Re: Arterial Embolization for Graves' Disease

Elaine,
I've made a note of the vstella address for a possible interview. Maybe we can combine a live patient interview with some medical insights from Dr. Xhou.
Valerie

By admin on   11/12/2008 1:02 AM

Re: Arterial Embolization for Graves' Disease

Hi Bredia,
The stress of bereavement is known to trigger and worsen symptoms in Graves' disease. I sympathize with your loss. Hopefully your doctor will increase your ATD dose temporarily. Best, Elaine

By emoore on   11/18/2008 3:50 PM

Re: Arterial Embolization for Graves' Disease

Hi Valerie,
That's a great idea to interview Ms. Stella for AHSTA.com. It would be wonderful if Dr. Xhou found a connection where he could train doctors at a medical center here. He trained a team in Canada, but when the radiologist retired there was no one trained to take over that role. Keep us posted, Elaine

By emoore on   11/18/2008 3:52 PM
 
     


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