Objective

Thyroid nodules are common and sometimes associated with cosmetic issues. Surgical treatment has several disadvantages, including visible scarring. High-intensity focused ultrasound (HIFU) is a recent noninvasive treatment for thyroid nodules. The present study aims to evaluate the effectiveness and safety of HIFU for the treatment of benign thyroid nodules.

Methods

We searched PubMed, Embase, and Cochrane Library for studies evaluating the outcomes of HIFU for patients with benign thyroid nodules. We conducted a meta-analysis by using a random effects model and evaluated the volume reduction ratio, treatment success rate, and incidence of treatment-related complications.

Results

Thirty-two studies were included in the systematic review. Only 14 studies were used in the meta-analysis because the other 18 involved data collected during overlapping periods. The average volume reduction ratios at 3, 6, and 12 months after treatment were 39.02% (95% CI: 27.57 to 50.47%, I²: 97.9%), 48.55% (95% CI: 35.53 to 61.57%, I²: 98.2%), and 55.02% (95% CI: 41.55 to 68.48%, I²: 99%), respectively. Regarding complications, the incidences of vocal cord paresis and Horner’s syndrome after HIFU were 2.1% (95% CI: 0.2 to 4.1%, I²: 14.6%) and 0.7% (95% CI: 0 to 1.9%, I²: 0%), respectively.

Conclusions

HIFU is an effective and safe treatment option for patients with benign thyroid nodules. However, the effects of HIFU on nodules of large sizes and with different properties require further investigation. Additional studies, particularly randomized controlled trials involving long-term follow-up, are warranted.

Clinical relevance statement

Surgical treatment for thyroid nodules often results in permanent visible scars and is associated with a risk of bleeding, nerve injury, and hypothyroidism. High-intensity focused ultrasound may be an alternative for patients with benign thyroid nodules.

Key Points

• The success rate of HIFU treatment for thyroid nodules is 75.8% at 6 months. Average volume reduction ratios are 48.55% and 55.02% at 6 and 12 months.

• The incidence of complications such as vocal fold paresis, Horner’s syndrome, recurrent laryngeal nerve palsy, hypothyroidism, and skin redness is low.

• HIFU is both effective and safe as a treatment for benign thyroid nodules.

中文翻译：

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HIFU治疗良性甲状腺结节的疗效：系统评价和荟萃分析

 客观的

甲状腺结节很常见，有时与美容问题有关。手术治疗有几个缺点，包括明显的疤痕。高强度聚焦超声（HIFU）是一种最新的甲状腺结节无创治疗方法。本研究旨在评估HIFU治疗良性甲状腺结节的有效性和安全性。

 方法

我们检索了 PubMed、Embase 和 Cochrane 图书馆，以查找评估 HIFU 对良性甲状腺结节患者的疗效的研究。我们利用随机效应模型进行了荟萃分析，评估了减容率、治疗成功率和治疗相关并发症的发生率。

 结果

系统评价中纳入了 32 项研究。荟萃分析中仅使用了 14 项研究，因为其他 18 项研究涉及在重叠时期收集的数据。治疗后3、6和12个月的平均体积缩小率分别为39.02%（95% CI：27.57至50.47%， I ² ：97.9%）、48.55%（95% CI：35.53至61.57%， I ² ：分别为 98.2%）和 55.02%（95% CI：41.55 至 68.48%， I ² ：99%）。关于并发症，HIFU术后声带麻痹和霍纳综合征的发生率分别为2.1%（95% CI：0.2至4.1%， I ² ：14.6%）和0.7%（95% CI：0至1.9%， I ² ：0） ％）， 分别。

 结论

HIFU对于良性甲状腺结节患者来说是一种有效且安全的治疗选择。然而，HIFU对大尺寸和不同性质的结节的影响需要进一步研究。需要进行更多研究，特别是涉及长期随访的随机对照试验。

临床相关性声明

甲状腺结节的手术治疗通常会导致永久性可见疤痕，并伴有出血、神经损伤和甲状腺功能减退的风险。高强度聚焦超声可能是良性甲状腺结节患者的替代选择。

 要点

• HIFU治疗甲状腺结节的成功率在6个月时为75.8%。 6个月和12个月时平均体积减少率为48.55%和55.02%。

•声带麻痹、霍纳综合征、喉返神经麻痹、甲状腺功能减退、皮肤发红等并发症发生率低。

• HIFU 治疗良性甲状腺结节既有效又安全。