title: Recombinant human thyrotropin before (131)I therapy in patients with nodular goitre: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Recombinant human thyrotropin (rhTSH) can be used to enhance radioiodine therapy for shrinking multinodular goitre. The aim of this meta-analysis was to compare the effectiveness of rhTSH pretreatment and radioiodine therapy with that of radioiodine alone for treating benign nodular goitre.
  
  
  METHODS
  The PubMed, EMBASE, Cochrane Library, Scopus and ClinicalTrials.gov databases were searched to identify studies published before September 2014. A meta-analysis was performed to calculate the pooled effect size using random-effects models. The primary outcome was the reduction in thyroid volume. Secondary outcomes included thyroid function, extent of tracheal compression, radioactive iodine uptake, incidence of hypothyroidism and other complications.
  
  
  RESULTS
  Nine RCTs including 416 patients were selected. The reductions in thyroid volume were significantly greater in the rhTSH pretreatment groups than those in the radioiodine alone groups at 12 months (weighted mean difference: 14·42%; 95% CI: 4·51-24·34% in high-dose rhTSH vs radioiodine alone; weighted mean difference: 19·66%; 95% CI: 3·67-35·65% in low-dose rhTSH vs radioiodine alone). The incidence of hypothyroidism in the high-dose rhTSH groups was significantly higher than that in the radioiodine alone groups. No significant difference in the incidence of hypothyroidism occurred between the low-dose rhTSH groups and the radioiodine alone groups.
  
  
  CONCLUSIONS
  The overall results indicated that using rhTSH before radioiodine therapy resulted in a greater thyroid volume reduction than radioiodine therapy alone. An increased incidence of hypothyroidism was observed in patients receiving high-dose rhTSH. Low-dose rhTSH before radioiodine therapy is more efficacious than radioiodine therapy alone for treating nontoxic benign thyroid nodules.
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yen-Ying
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Division of General Surgery, Department of Surgery, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|Center for Evidence-Based Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: You-Meei
authors.initials: YM
authors.lastname: Lin
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wuan-Jin
authors.initials: WJ
authors.lastname: Leu
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Jui-Chia
authors.initials: JC
authors.lastname: Chang
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chi-Lien
authors.initials: CL
authors.lastname: Hsiao
authors.affiliation: Department of Pharmacy, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Meng-Ting
authors.initials: MT
authors.lastname: Hsu
authors.affiliation: Division of Endocrinology & Metabolism, Department of Internal Medicine, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: An-Tsz
authors.initials: AT
authors.lastname: Hsieh
mesh_terms: D017024:Chemotherapy, Adjuvant; D006044:Goiter, Nodular / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D011994:Recombinant Proteins / Q000008:administration & dosage; D013961:Thyroid Gland / Q000187:drug effects*; D013972:Thyrotropin / Q000008:administration & dosage*
chemical_list: D007457:Iodine Radioisotopes; D011994:Recombinant Proteins; D013972:Thyrotropin