Efficacy and safety of thermal ablation for non-nodular hyperthyroidism: a systematic review and meta-analysis

Conventional treatments for non-nodular hyperthyroidism, including antithyroid drugs, radioactive iodine, and surgery, are limited by high relapse rates, the risk of permanent hypothyroidism, and surgical complications. Thermal ablation has emerged as a minimally invasive alternative; however, supporting evidence remains limited. This study systematically evaluated the efficacy and safety of ultrasound-guided radiofrequency and microwave ablation for non-nodular hyperthyroidism.

A systematic review and meta-analysis of observational cohort studies published up to September 2024 was conducted using PubMed, Web of Science, and major Chinese databases. The primary outcomes included changes in thyroid function parameters (TSH, FT3, FT4), TRAb levels, and thyroid volume. Random-effects models were applied to pool weighted mean differences (WMDs).

Ten cohort studies comprising 208 patients were included. Thermal ablation significantly increased TSH levels at 1, 3, 6, and 12 months (e.g. 12-month WMD = 1.91, 95% CI [0.33, 3.49]) and reduced FT3 and FT4 levels at 3, 6, and 12 months. Thyroid volume decreased significantly across all time points. Heterogeneity was substantial (I² > 80% in most analyses). Reported adverse events were generally mild and transient, including hoarseness and hypothyroidism.

Thermal ablation appears to improve thyroid function and reduce thyroid volume in patients with non-nodular hyperthyroidism, demonstrating an acceptable safety profile. However, the evidence remains limited by the observational design, small sample sizes, and considerable heterogeneity. High-quality randomized controlled trials are warranted to validate these findings.