Elisa Gatta, Riccardo Morandi, Claudio Casella, Roberto Negro, Mario Rotondi, Carlo Cappelli
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引用次数: 0
Abstract
Introduction: Ultrasound-guided thermal ablation (U-GTA) techniques, including radiofrequency ablation (RFA) and microwave ablation (MWA), have recently been proposed as minimally invasive alternatives to surgery or radioiodine (RAI) therapy for patients with Graves' disease (GD) who are unresponsive to antithyroid drugs. However, evidence supporting its effectiveness and safety remains limited.
Methods: A PubMed/MEDLINE, Web of Science, and Scopus research updated until January 31, 2026, was performed. The review question was: What is the euthyroidism rate (outcome) one year after U-GTA (intervention) in Graves' disease (population)? Two reviewers independently conducted the study screening, data extraction, and risk of bias assessment. A random-effects model was adopted to pool the prevalence with corresponding 95% confidence intervals.
Results: Four studies comprising 82 patients (88% female) were included in the analysis. Approximately 2.4% of patients required levothyroxine replacement after U-GTA. Thyroid volume significantly decreased following treatment, and baseline thyroid volume was identified as a predictor of relapse in one study. A transient increase in anti-TSH receptor antibodies was observed one month after U-GTA, followed by a subsequent decline. No worsening or new onset of Graves' orbitopathy was reported. Post-procedural adverse events occurred in 6.1% of patients and were transient. At 12 months, pooled euthyroidism rate was 67.0% (95% CI 54-78), with low heterogeneity (I² = 0%).
Discussion: U-GTA appears to induce biochemical remission in approximately two-thirds of selected patients with persistent or relapsed GD, with a favourable short-term safety profile and preservation of thyroid function in most cases. However, remission rates remain lower than those typically reported for definitive surgical treatment, and current evidence is limited to small, non-randomized studies with relatively short follow-up. Larger prospective comparative trials with standardized protocols are required to define the role of U-GTA within current management strategies for GD.
超声引导热消融（U-GTA）技术，包括射频消融（RFA）和微波消融（MWA），最近被提议作为手术或放射性碘（RAI）治疗对抗甲状腺药物无反应的格雷夫斯病（GD）患者的微创替代方案。然而，支持其有效性和安全性的证据仍然有限。方法：PubMed/MEDLINE， Web of Science和Scopus研究更新至2026年1月31日。回顾的问题是：格雷夫斯病（人群）在U-GTA（干预）后一年的甲状腺功能亢进率（结果）是多少？两名审稿人独立进行了研究筛选、数据提取和偏倚风险评估。采用随机效应模型，以相应的95%置信区间汇总患病率。结果：4项研究共纳入82例患者（88%为女性）。约2.4%的患者在U-GTA术后需要左旋甲状腺素替代。治疗后甲状腺体积显著减少，一项研究发现，基线甲状腺体积可作为复发的预测因子。在U-GTA一个月后观察到抗tsh受体抗体的短暂增加，随后下降。Graves眼病未见恶化或新发。术后不良事件发生在6.1%的患者中，并且是短暂的。12个月时，合并甲状腺功能亢进率为67.0% (95% CI 54-78)，异质性较低（I²= 0%）。讨论：U-GTA似乎在大约三分之二的持续性或复发性GD患者中诱导生化缓解，在大多数情况下具有良好的短期安全性和甲状腺功能的保存。然而，缓解率仍然低于明确手术治疗的典型报告，目前的证据仅限于小型，非随机研究，随访时间相对较短。需要采用标准化方案进行更大规模的前瞻性比较试验，以确定U-GTA在当前GD管理策略中的作用。
期刊介绍：
Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology.
Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted.
Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.
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