Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan.
Endocrine. 2023 Aug;81(2):223-230. doi: 10.1007/s12020-023-03371-1. Epub 2023 Apr 28.
Several studies were conducted over the years to find a significant association between non-surgical therapies such as Antithyroid Drug (ATD) Therapy and Radio-iodo therapy (RIT) with Graves' disease (GD) remission and relapse. However, these investigations did not have a specific focus on the age category of children and adolescents. Hence, this Research is performed to assess the association of non-surgical therapy (ATD and RIT) with Graves' disease (GD) remission and relapse in the children and adolescent population.
A systematic review and meta-analysis of observational studies and clinical trials were carried out.
A systematic search of PubMed, EMBASE, and SCOPUS from their inception till April 2022 was performed for studies stating an association between ATD therapy and GD remission and relapse in participants 1-17 years old. The random-effects model was used in the meta-analysis to provide a pooled proportion of both primary outcomes. The quality and each study were assessed using the Newcastle Ottawa Scale (NOS).
From 6195 studies searched from the databases, only 16 relevant articles remained after a detailed evaluation. These studies, having a total of 2557 patients aged 5-17 years, were involved in the analysis with a pooled estimate showing a significant association of ATD therapy with GD remission (Estimate: 0.400, 95% Confidence interval: 0.265-0.535; I^2 = 98.16%) and with GD relapse (Estimate: 0.359, 95% Confidence interval: 0.257-0.461; I^2 = 98.26%). Subgroup analyses were conducted to assess the remission rate of different therapies suggesting that antithyroid drugs play a significant role in the remission of the patients. All included studies were classified as moderate quality.
Following meta-analysis suggested that the ATD used in the analysis is effective in remitting GD in the children and adolescents population. Nevertheless, long-term RIT therapy and thyroidectomy leads to hypothyroidism. Still, large-sample, and high-quality studies targeting ATDs' use in children and adolescents with long-term surveillance of prognosis are needed.
多年来进行了多项研究，以寻找非手术治疗（如抗甲状腺药物（ATD）治疗和放射性碘治疗（RIT））与格雷夫斯病（GD）缓解和复发之间的显著关联。然而，这些研究没有特别关注儿童和青少年的年龄类别。因此，本研究旨在评估非手术治疗（ATD 和 RIT）与儿童和青少年人群中 GD 缓解和复发的关联。
对观察性研究和临床试验进行了系统的综述和荟萃分析。
从其成立到 2022 年 4 月，对 PubMed、EMBASE 和 SCOPUS 数据库进行了系统搜索，以查找表明 ATD 治疗与 1-17 岁参与者 GD 缓解和复发之间存在关联的研究。荟萃分析采用随机效应模型提供两种主要结局的汇总比例。使用纽卡斯尔-渥太华量表（NOS）评估质量和每项研究。
从数据库中搜索了 6195 项研究，经过详细评估后只剩下 16 篇相关文章。这些研究共纳入了 2557 名 5-17 岁的患者，进行了分析，汇总估计显示 ATD 治疗与 GD 缓解（估计值：0.400，95%置信区间：0.265-0.535；I^2=98.16%）和 GD 复发（估计值：0.359，95%置信区间：0.257-0.461；I^2=98.26%）之间存在显著关联。进行了亚组分析以评估不同治疗方法的缓解率，表明抗甲状腺药物在患者缓解中起重要作用。所有纳入的研究均被归类为中等质量。
荟萃分析表明，分析中使用的 ATD 可有效缓解儿童和青少年中的 GD。然而，长期 RIT 治疗和甲状腺切除术会导致甲状腺功能减退。仍需要针对儿童和青少年使用 ATD 进行大型、高质量的研究，并对预后进行长期监测。
