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Riesgos de mortalidad asociados con los medicamentos antitiroideos, el yodo radiactivo y la cirugía para el

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

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La cirugía para el hipertiroidismo reduce significativamente la mortalidad por todas las causas y la cardiovascular en comparación con los medicamentos antitiroideos (ATD) o el yodo radiactivo (RAI). Los eventos adversos cardiovasculares importantes y los riesgos de mortalidad por cáncer fueron similares en todos los tratamientos.

Palabras clave:
Medicamentos para la tiroideshipertiroidismola mortalidadMetaanálisis de la redyodo radiactivotiroidectomía

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Área de la Ciencia:

  • Endocrinología y Metabolismo
  • Medicina cardiovascular
  • Oncología quirúrgica

Sus antecedentes:

  • Las opciones de tratamiento del hipertiroidismo incluyen medicamentos antitiroideos (ATD), yodo radiactivo (RAI) y cirugía.
  • Los resultados comparativos a largo plazo de estos tratamientos de hipertiroidismo son cruciales para la toma de decisiones clínicas.

Objetivo del estudio:

  • Realizar una revisión sistemática y un metanálisis de red (NMA) que evalúe los resultados a largo plazo de ATD, RAI y cirugía para el hipertiroidismo.
  • Comparar los riesgos de mortalidad por todas las causas, mortalidad cardiovascular, eventos adversos cardiovasculares importantes (MACE) y mortalidad por cáncer entre las modalidades de tratamiento.

Principales métodos:

  • Búsqueda sistemática de la literatura de las principales bases de datos (PubMed, EMBASE, Web of Science, Cochrane Library) hasta el 7 de marzo de 2025.
  • Metaanálisis en red de 12 estudios observacionales (192.208 pacientes) en los que se utilizaron modelos de efectos aleatorios para calcular los ratios de riesgo (RR) y los intervalos de confianza (IC).
  • El estudio fue registrado con PROSPERO (CRD420250543380) y siguió las directrices de PRISMA-NMA.

Principales resultados:

  • La cirugía se asoció con riesgos significativamente reducidos de mortalidad por cualquier causa (HR 0,58 [0,45-0,75] frente a ATD; HR 0,68 [0,56-0,84] frente a RAI) y mortalidad cardiovascular (HR 0,43 [0,19-0,98] frente a ATD; HR 0,55 [0,33-0,93] frente a RAI).
  • No se observaron diferencias significativas en el MACE o en la mortalidad por cáncer entre los grupos de tratamiento.
  • El análisis incluyó una gran cohorte de pacientes, predominantemente tratados con ATD.

Conclusiones:

  • La cirugía para el hipertiroidismo demuestra un beneficio significativo en la supervivencia, reduciendo tanto la mortalidad por todas las causas como la cardiovascular en comparación con ATD y RAI.
  • La modalidad de tratamiento no influyó en los riesgos de ECMA o de mortalidad por cáncer.
  • Los hallazgos de los estudios observacionales requieren una interpretación cautelosa debido a la potencial heterogeneidad y sesgo de selección.