Xiaobo Zhang

Giant nodular goiters are hypervascular benign thyroid lesions whose surgical resection carries substantial risks. This study evaluates the feasibility, efficacy, and safety of transarterial chemoembolization (TACE) with bleomycin for symptomatic giant nodular goiter. This single-center retrospective study included patients with giant nodular goiter (≥ 4 cm) treated with TACE using 15,000 U bleomycin and 200-400 μm drug-loaded microspheres between May 2024 and May 2025. Primary outcomes were volumetric reduction and symptom relief. Secondary outcomes included complications and thyroid function changes. Non-parametric paired comparisons were used for statistical analysis. Fifty-one cases (mean age, 58 years [IQR, 42.75-64]) were evaluated. Technical success was achieved in all patients. Median goiter volume decreased from 192.7 cm³ (IQR, 125.4-350.1) to 70.45 cm³ (IQR, 54.04-102.1) at 6-month follow-up (p < 0.0001), representing a median volume reduction rate of 72.13% (IQR, 62.00-78.59). All patients achieved complete symptom remission by 1 month. No major procedure-related adverse events occurred. TACE with bleomycin is a safe and feasible minimally invasive option for symptomatic giant nodular goiter, achieving sustained volume reduction and complete symptom remission without major complications. Question Symptomatic giant nodular goiters pose substantial surgical risk; effective minimally invasive alternatives with durable volume reduction and symptom relief are lacking. Findings TACE with bleomycin-loaded microspheres achieved a median 72.13% volume reduction at 6 months with 100% symptomatic remission and no major complications in all patients. Clinical relevance TACE with bleomycin provides a safe, minimally invasive treatment option for patients with symptomatic giant nodular goiter who are unwilling or medically unfit for surgery, potentially reducing operative morbidity and improving quality of life.