Department of Nuclear Medicine and Thyroid Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Section of Endocrinology and Diabetology, Ospedale Israelitico, Rome, Italy.
Eur J Clin Invest. 2015 Jul;45(7):739-44. doi: 10.1111/eci.12456. Epub 2015 Jun 1.
International guidelines significantly diverge on the effectiveness of thyroid scintigraphy (TS) in the initial work-up of thyroid nodules. In particular, the role of TS to detect or exclude the presence of autonomously functioning thyroid nodules (AFTN) in patients with normal serum thyrotropin (TSH) is still a matter to debate. Here, we aimed to review the literature on the prevalence of normal TSH value among patients with AFTN and meta-analyse data of the retrieved eligible papers.
A comprehensive literature search of studies published from January 2000 to December 2014 on AFTN detected by TS was performed. Records reporting serum TSH values in AFTN were selected. Pooled prevalence of AFTN with normal TSH values was calculated on a per-patient analysis including 95% confidence intervals (95% CI).
Eight records including 2761 AFTN were selected for the meta-analysis. Pooled prevalence of AFTN with normal TSH detected by TS was 50% (95% CI: 32-68%). Selection bias in the included studies and heterogeneity among studies were potential limitations of the meta-analysis.
Present meta-analysis shows that about one in two patients with AFTN demonstrated by TS has a TSH value within normal references. As a consequence, TSH measurement may not be considered as effective as a single tool to detect or exclude AFTN, and TS remains mandatory.
国际指南在甲状腺闪烁显像（TS）在甲状腺结节初始检查中的有效性方面存在显著差异。特别是，TS 检测或排除正常血清促甲状腺激素（TSH）患者中自主功能性甲状腺结节（AFTN）的作用仍然存在争议。在这里，我们旨在回顾有关 AFTN 患者中正常 TSH 值的患病率的文献，并对检索到的合格论文进行荟萃分析数据。
对 2000 年 1 月至 2014 年 12 月期间通过 TS 检测到的 AFTN 的研究进行了全面的文献检索。选择报告 AFTN 血清 TSH 值的记录。在包括 95%置信区间（95%CI）的每位患者分析中计算出 TSH 值正常的 AFTN 的汇总患病率。
共选择了 8 份记录，包括 2761 例 AFTN 进行荟萃分析。TS 检测到的 TSH 值正常的 AFTN 的汇总患病率为 50%（95%CI：32-68%）。荟萃分析存在纳入研究的选择偏倚和研究间的异质性。
目前的荟萃分析表明，大约每两名通过 TS 显示为 AFTN 的患者中就有一名患者的 TSH 值在正常参考范围内。因此，TSH 测量可能不能被认为是检测或排除 AFTN 的有效单一工具，并且 TS 仍然是强制性的。
