| Graves' disease (GD) is one of the most common thyroid diseases. The classic methods for treating GD are anti-thyroid drug (ATD) therpy, radioiodine (131I) therapy and surgical subtotal thyroidectomy which are of diferrent advantages and disadvantages respectively and are not the best ones. As it was widely used, interventional medical technique presented us a new method in treating GD. Since the pilot report given by Russian Dr. Galkin in 1994, there have been several similar reports within China, most of which were lelatively short-term experience but not systemic research. Up to date there are not exact criteria in how many arteries that should be embolized and there are not comparative study on the effect of diferrent embolizing materials and specific study on the complications. Therefore, this study would be focused on these aspects.Part one Blood Supply to the Thyroid with GD: Colour Doppler Sonography versus DSA Objective: Investigating the diameter and relative area of supplying thyroid of each thyroid-artery, comparing the data detected by sonography with that measured on DSA in order to provide related information for embolizing thyroid-arteries in treating hyperthyroidism. Methods: 63 cases of GD undertook arteriography of thyroid, male 13 aged from 18 to 63years, average 36.8 years; female 50 aged from 12 to 65years, average 26.1years, 60 cases of whom have reserved data. The diameter and relative area (ratio to single side thyroid) were measured on the DSA. If an artery supplied more than 60% tissue of thyroid (single side), it was considered as the dominant supplying one and 40-60% as even to the other one (superior to inferior thyroid-artery). 41patients had colour Doppler sonography examination. The data from sonography were compared with that from DSA.Result: The diameters of right superior and inferior thyroid-arteries ranged from 2.2mm to 6.0mm(3.8(0.97mm) and from 1.7mm to 5.6mm(3.6(1.29mm) respectively, showing no significant difference (t=0.8609, P>0.05). The diameters of left superior and inferior thyroid-arteries ranged from 2.4mm to 6.0mm(3.8(0.97mm) and from 1.0mm to 5.2mm(3.2(1.19mm) respectively, showing statistically significant difference (t=3.0891, P<0.005). Comparing the right thyroid-arteries with the left ones, there was almost no difference between the superior ones and the right inferior thyroid-arteries were larger than the left ones but without statistical significance (t=1.8033, P>0.05). Of all cases (60), the right thyroid was supplied almost evenly by right superior and inferior arteries in 25 and dominantly supplied by inferior artery in 2, which altogether accounted for 45%(27/60). The left thyroid was supplied almost evenly by superior and inferior arteries in 36.7%( 22/60) cases and dominantly supplied by inferior artery in 13.3%( 8/60) cases, which altogether accounted for 50%(30/60). A lot of communication occurred within thyroidal arteries. On sonography, the thyroid enlarged and its blood vesseles widened with increase of blood flow showing "thyroid inferno". The diameters and blood flow quantities of right superior and inferior thyroidal arteries were 2.04(0.31mm,147.7(64.1 ml/min and 2.16(0.41mm,144.4(77.7 ml/min respectively. The diameters and blood flow quantities of left superior and inferior thyroidal arteries were 2.04(0.36mm,132.8(49.8ml/min and 2.03(0.34mm,128.1(63.9 ml/min respectively and difference among the related parameters was not significant. About 70% parameters got from sonography could meet that from DSA. Conclusion: The diameters of thyroid-arteries increased at hyperthyroidism. The superior thyroid-arteries as dominant supplying ones were found in only about 50% cases. So nearly half patients with GD will not be completely cured by this way if only bilateral superior thyroid-arteries are embolized. Before TAE colour Doppler sonography may reveal enlargement of thyroid and increase of blood flow in all cases and give relatively precise data for about 70% patients.Part Two Analysis of Efficacy of Thyroid... |
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