Effects of energy-based ablation on thyroid function in treating benign thyroid nodules: a systematic review and meta-analysis

Whether thyroid function would be affected by ablation remains controversial. This systematic review and meta-analysis aimed to investigate the effects of energy-based ablation on thyroid function in treating benign thyroid nodules. EMBASE, PubMed, Cochrane Library, and Web of Science databases were searched. The mean difference (MD) or standard MD (SMD) was applied to assess changes in thyroid function, thyroglobulin (Tg), and antibodies after ablation. RevMan version 5.3 was used for data synthesis. Forty-two studies involving 6380 patients were eligible. The pooled results revealed significant decrease of 1-day thyroid-stimulating hormone (95% CI, −0.67 to −0.14), significant increase of 1-day, 1-week, and 1-month free thyroxine (95% CI, 1.57 to 5.28; 95% CI, 0.61 to 2.42; 95% CI, −0.76 to −0.15), 1-day and 1-week Tg level (95% CI, 0.40 to 0.81; 95% CI, 0.21 to 1.29), 6-month anti-thyroglobulin antibodies (95% CI, 0.02 to 0.26), 1- and 3-month thyroperoxidase antibody (95% CI, 0.02 to 0.22; 95% CI, 0.17 to 0.43), and 1-day, 1-, and 3-month thyrotrophin receptor antibody (95% CI, 0.10 to 0.43; 95% CI, 0.00 to 0.30; 95% CI, 0.13 to 0.36) after ablation. No statistically significant differences were found in these six indicators in the longer term. The results of subgroup analysis were similar to the pooled results. No significant publication bias was found. Energy-based ablation was more likely to have negative effects on thyroid function and antibodies and led to transient increase in Tg level in the short term. However, most of the patients would not develop any thyroid dysfunction in the long-term follow-up.

消融治疗是否会对甲状腺功能造成影响，目前仍存在争议。本系统评价与荟萃分析旨在探讨能量消融（energy-based ablation）在治疗甲状腺良性结节时对甲状腺功能的影响。本研究检索了EMBASE、PubMed、Cochrane图书馆及Web of Science数据库，采用均数差（mean difference, MD）或标准化均数差（standardized mean difference, SMD）评估消融术后甲状腺功能、甲状腺球蛋白（thyroglobulin, Tg）及相关抗体的变化情况，并使用RevMan 5.3软件进行数据合成分析。最终纳入42项符合纳入标准的研究，共计6380例患者。合并分析结果显示，消融术后1天的促甲状腺激素（thyroid-stimulating hormone）水平显著降低（95%置信区间：-0.67至-0.14）；术后1天、1周及1个月的游离甲状腺素水平显著升高（95%置信区间分别为1.57至5.28、0.61至2.42、-0.76至-0.15）；术后1天、1周的Tg水平显著升高（95%置信区间分别为0.40至0.81、0.21至1.29）；术后6个月的抗甲状腺球蛋白抗体（anti-thyroglobulin antibodies）水平显著升高（95%置信区间：0.02至0.26）；术后1、3个月的甲状腺过氧化物酶抗体（thyroperoxidase antibody）水平显著升高（95%置信区间分别为0.02至0.22、0.17至0.43）；术后1天、1个月及3个月的促甲状腺素受体抗体（thyrotrophin receptor antibody）水平显著升高（95%置信区间分别为0.10至0.43、0.00至0.30、0.13至0.36）。上述六项指标在长期随访中未观察到统计学显著差异。亚组分析结果与合并分析结果一致，且未检测到显著的发表偏倚。能量消融更易对甲状腺功能及相关抗体产生负面影响，并可在短期内导致Tg水平一过性升高，但在长期随访中，多数患者不会出现甲状腺功能异常。