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Radioiodine versus radiofrequency ablation to treat autonomously functioning thyroid nodules: a systematic review and comparative meta-analysis

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

An Editorial to this article was published on 15 March 2024

Abstract

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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco SA, Clinica Moncucco, Via Soldino 10, 6900, Lugano, Switzerland

    Luca Giovanella

  2. Clinic for Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland

    Luca Giovanella

  3. Biostatistic Unit, Mathsly Research, Rome, Italy

    Maria Luisa Garo

  4. Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, Messina, Italy

    Alfredo Campenní

  5. Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, 10000, Zagreb, Croatia

    Petra Petranović Ovčariček

  6. School of Medicine, University of Zagreb, 10000, Zagreb, Croatia

    Petra Petranović Ovčariček

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Contributions

The study was conceived and designed by Luca Giovanella. Material preparation and data collection were performed by all authors. Data analysis was performed by Maria Luisa Garo. The first draft of the manuscript was written by Luca Giovanella and Maria Luisa Garo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Luca Giovanella.

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Giovanella, L., Garo, M.L., Campenní, A. et al. Radioiodine versus radiofrequency ablation to treat autonomously functioning thyroid nodules: a systematic review and comparative meta-analysis. Eur J Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s00259-024-06625-w

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