Comparing efficacy and safety of oral drugs in treatment of hyperthyroidism: a systematic review and network meta-analysis

TL;DR

This study compares the effectiveness and safety of various oral drugs for treating hyperthyroidism using a network meta-analysis of 151 studies.

Contribution

The study provides a comprehensive ranking of drug interventions for hyperthyroidism based on efficacy and safety using network meta-analysis.

Findings

I-131+LC showed the highest efficacy rate in treating hyperthyroidism.

I-131+PTU was most effective in reducing FT3 and adverse reactions.

I-131 was top-ranked for increasing TSH and reducing FT4.

Abstract

Thyrotoxicosis refers to a condition where there is an excess of thyroid hormone production by the thyroid gland itself, leading to a form of hyperthyroidism.

This study is based on systematic review and network meta-analysis methods, aiming to provide a more reliable basis for the selection of clinical treatment plans by comprehensively considering the efficacy and safety of different drugs in treating hyperthyroidism, including the regulation of thyroid hormone levels and potential adverse reactions.

Computerized searches were conducted in eight major domestic and international databases (PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, WANFANG DATA, VIP) for randomized controlled trials (RCTs) on the efficacy of oral medications in improving the treatment outcomes of patients with hyperthyroidism. The search period covered from the inception of each database to October 2025. All researchers independently screened the literature, extracted data, and assessed the quality of the studies. For studies meeting the quality criteria, data analysis was performed using Stata 17.0 and RevMan 5.4 software.

A total of 151 articles were ultimately included, involving 14,158 patients, with 7,084 in the treatment group and 7,074 in the control group. The network meta-analysis showed that in terms of total effective rate, the top three interventions with the highest Surface Under the Cumulative Ranking Curve (SUCRA) probability ranking curve area were I-131 (Iodine-131)+LC (lithium carbonate), MMI (Methimazole)+PHT (Propranolol), and I-131; in terms of reducing Free Triiodothyronine (FT3), the top three interventions with the highest SUCRA probability ranking curve area were MMI+PDN (prednisone), I-131+LC, and I-131; in terms of reducing free tetraiodothyronine (FT4), the top three interventions with the highest SUCRA probability ranking curve area were I-131+PTU (Propylthiouracil), I-131+LC, and I-131; in terms of increasing thyroid-stimulating hormone (TSH), the top three interventions with the highest SUCRA probability ranking curve area were I-131+PTU, I-131, and MMI+PDN; in terms of reducing adverse reactions, the top three interventions with the highest SUCRA probability ranking curve area were I-131+PTU, I-131, and I-131+MMI.

This study indicates that among the interventions for treating hyperthyroidism, I-131+LC has a higher efficacy rate compared to other treatments, I-131+PTU is superior in reducing FT3, increasing TSH and reducing adverse reactions compared to other treatments. Due to the limitations in the quantity and quality of the included studies, the aforementioned conclusions await further validation from more large-sample, high-quality, and multicenter studies. PROSPERO study number CRD42024566298.

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