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Related Experiment Video

Updated: Sep 9, 2025

Computer-Aided Three-Dimensional Visualization in the Treatment of Locally Advanced Thyroid Cancer
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Mortality Risks Associated with Antithyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic

Carol Chiung-Hui Peng1, Brianna R Spiegel2, David Flynn3

  • 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.

Thyroid : Official Journal of the American Thyroid Association
|September 2, 2025
PubMed
Summary

Surgery for hyperthyroidism significantly reduces all-cause and cardiovascular mortality compared to antithyroid drugs (ATD) or radioactive iodine (RAI). Major adverse cardiovascular events and cancer mortality risks were similar across treatments.

Keywords:
antithyroid drugshyperthyroidismmortalitynetwork meta-analysisradioactive iodinethyroidectomy

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Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Medicine
  • Surgical Oncology

Background:

  • Hyperthyroidism management options include antithyroid drugs (ATD), radioactive iodine (RAI), and surgery.
  • Long-term comparative outcomes of these hyperthyroidism treatments are crucial for clinical decision-making.

Purpose of the Study:

  • To conduct a systematic review and network meta-analysis (NMA) evaluating long-term outcomes of ATD, RAI, and surgery for hyperthyroidism.
  • To compare risks of all-cause mortality, cardiovascular mortality, major adverse cardiovascular events (MACE), and cancer mortality across treatment modalities.

Main Methods:

  • Systematic literature search of major databases (PubMed, EMBASE, Web of Science, Cochrane Library) up to March 7, 2025.
  • Network meta-analysis of 12 observational studies (192,208 patients) using random-effects models to calculate hazard ratios (HR) and confidence intervals (CI).
  • Study registered with PROSPERO (CRD420250543380) and followed PRISMA-NMA guidelines.

Main Results:

  • Surgery was associated with significantly reduced risks of all-cause mortality (HR 0.58 [0.45-0.75] vs. ATD; HR 0.68 [0.56-0.84] vs. RAI) and cardiovascular mortality (HR 0.43 [0.19-0.98] vs. ATD; HR 0.55 [0.33-0.93] vs. RAI).
  • No significant differences in MACE or cancer mortality were observed among the treatment groups.
  • The analysis included a large patient cohort, predominantly treated with ATD.

Conclusions:

  • Surgery for hyperthyroidism demonstrates a significant survival benefit, reducing both all-cause and cardiovascular mortality compared to ATD and RAI.
  • Treatment modality did not influence risks for MACE or cancer mortality.
  • Findings from observational studies necessitate cautious interpretation due to potential heterogeneity and selection bias.