From the Research
Patients with hereditary angioedema (HAE) undergoing fine needle aspiration (FNA) of thyroid nodules are at increased risk of experiencing an angioedema episode due to local tissue trauma, and therefore, prophylactic medication is strongly recommended before the procedure, as supported by the most recent study 1. The risk of angioedema episodes in patients with HAE undergoing FNA of thyroid nodules is a significant concern due to the potential for life-threatening airway compromise.
- The pathophysiology of HAE involves a deficiency in C1 esterase inhibitor, leading to unregulated bradykinin production and increased vascular permeability 1.
- Prophylactic medication options include C1 esterase inhibitor concentrate (Berinert or Cinryze) 1000 units IV 1-2 hours before the procedure, or icatibant (Firazyr) 30 mg subcutaneously 30-60 minutes prior, as recommended by recent studies 2, 1.
- Alternatively, attenuated androgens like danazol 200 mg three times daily can be started 5 days before and continued 2-3 days after the procedure, as suggested by earlier studies 3, 4.
- During the FNA, minimal tissue manipulation is advised, and the procedure should be performed in a setting with emergency medications readily available, including additional doses of C1 inhibitor concentrate, icatibant, and epinephrine, as emphasized by recent guidelines 2, 5.
- Patients should be observed for at least 4 hours post-procedure for signs of angioedema, as recommended by recent studies 1, 5. The most recent and highest quality study 1 provides the most up-to-date guidance on the management of HAE, and its recommendations should be prioritized in clinical practice.