Summary of findings 1. Recombinant human thyrotropin‐aided radioiodine compared with radioiodine for non‐toxic multinodular goitre.
| Recombinant human thyrotropin‐aided radioiodine compared with radioiodine for non‐toxic multinodular goitre | ||||||
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Patient: people with non‐toxic multinodular goitre Settings: outpatients (5 studies); in hospital (1 study) Intervention: recombinant human thyrotropin (rhTSH)‐aided radioiodine Comparison: radioiodine only | ||||||
| Outcomes | Risk with radioiodine only | Risk with rhTSH aided radioiodine | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments |
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Health‐related quality of life Assessed with thyroid disease‐specific questionnaire ThyPRO Follow‐up: 36 months |
See comment | 85 (1) | ⊕⊝⊝⊝ very lowa |
There were no clear differences in symptom improvement in the 17 goitre‐specific questions and overall quality of life question among the treatment groups at 6 and 36 months | ||
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Hypothyroidism Follow‐up: 12 to 36 months |
131 per 1000 | 306 per 1000 (184 to 508) | RR 2.53 (1.52 to 4.20) | 321 (6) | ⊕⊕⊕⊝ moderateb | |
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Adverse events Follow‐up: 12 to 36 months |
484 per 1000 | 600 per 1000 (455 to 789) | RR 1.24 (0.94 to 1.63) | 321 (6) | ⊕⊕⊝⊝ lowc | The fixed‐effect model showed a RR of 1.23, 95% CI 1.02 to 1.49 in favour of radioiodine only |
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Thyroid volume Follow‐up: 12 to 36 months |
The mean reduction in thyroid volume ranged across control groups from 12.7% to 46.1% | The mean reduction in thyroid volume in the intervention groups was 11.9% higher (4.4% higher to 19.4% higher) | — | 268 (6) | ⊕⊕⊕⊝ moderateb | |
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All‐cause mortality Follow‐up: 24 months |
See comment | 28 (1) | ⊕⊝⊝⊝ very lowd | Only 1 study reported deaths: 1/10 participants in the radioiodine only group died compared with 0/18 participants in the rhTSH aided radioiodine group | ||
| Costs | Not reported | |||||
| CI: confidence interval; MD: mean difference; rhTSH: recombinant human thyrotropin ; RR: risk ratio; ThyPRO: thyroid‐related patient‐reported outcomes. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aDowngraded by three levels because of very serious imprecision (low median sample size, only 1 study reporting outcome) bDowngraded by one level because of imprecision (low median sample size) cDowngraded by two levels because of serious imprecision (low median sample size, CI consistent with benefit and harm) dDowngraded by three levels because of very serious imprecision (one study only with small number of participants, very low number of events)