Purpose

Radioiodine (RAI) is a well-established first-line therapy for autonomously functioning thyroid nodules (AFTN). Radiofrequency ablation (RFA) is a minimally invasive procedure that has been proposed as an alternative treatment option for hyperthyroidism caused by AFTN. Although RFA has been shown to be useful for reducing nodule volume and improving TSH levels in AFTN, no comprehensive comparative clinical studies have been proposed to evaluate the overall response to RFA treatment. The aim of this comparative systematic review and meta-analysis was to evaluate the response of RAI and RFA treatments in AFTN.

Methods

A systematic search strategy was applied in PubMed, Web of Science, Scopus, Cochrane Library, and ClinicalTrials.gov until July 2023 without time or language restrictions. Studies investigating the response to RAI and/or RFA treatment in AFTN patients 6 and/or 12 months after treatment were included. The risk of bias was assessed based on the study design. Random-effect models were used for the meta-analysis.

Results

Twenty-three articles (28 reports) met the inclusion criteria and were included in the study. Overall, RAI therapy was found to have a significantly higher treatment response (94%) than RFA (59%), although the volume of AFTNs was reduced to a similar extent. In the direct comparison (n = 3 studies), RFA showed a higher risk of non-response than RAI (RR, 1.24; 95% CI, 0.94–1.63; z = 1.55; p = 0.12).

Conclusions

Our results demonstrate the superiority of RAI over RFA in terms of success rates and safety profile and confirm RAI as the first choice for the treatment of AFTNs.

中文翻译：

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放射性碘与射频消融治疗自主功能甲状腺结节：系统评价和比较荟萃分析

目的

放射性碘 (RAI) 是治疗自主功能甲状腺结节 (AFTN) 的成熟一线疗法。射频消融 (RFA) 是一种微创手术，已被提议作为 AFTN 引起的甲状腺功能亢进症的替代治疗选择。尽管 RFA 已被证明可有效减少 AFTN 结节体积并提高 TSH 水平，但尚未提出全面的比较临床研究来评估 RFA 治疗的总体反应。本次比较系统评价和荟萃分析的目的是评估 RAI 和 RFA 治疗在 AFTN 中的反应。

方法

截至 2023 年 7 月，系统检索策略已在 PubMed、Web of Science、Scopus、Cochrane Library 和 ClinicalTrials.gov 中应用，没有时间或语言限制。纳入了调查 AFTN 患者治疗后 6 个月和/或 12 个月对 RAI 和/或 RFA 治疗反应的研究。根据研究设计评估偏倚风险。随机效应模型用于荟萃分析。

结果

23 篇文章（28 份报告）符合纳入标准并被纳入本研究。总体而言，RAI 疗法的治疗反应 (94%) 显着高于 RFA (59%)，尽管 AFTN 的体积减少到类似程度。在直接比较中（n  = 3 项研究），RFA 显示无反应风险高于 RAI（RR，1.24；95% CI，0.94–1.63；z  = 1.55；p  = 0.12）。

结论

我们的结果证明了 RAI 在成功率和安全性方面优于 RFA，并证实 RAI 是治疗 AFTN 的首选。