Key research findings

The COVID-19 pandemic has negatively impacted the surgical treatment of goiters and benign thyroid nodules. Choosing the appropriate patients for treatment is crucial for improving their overall health. 3

The human gut microbiome plays a significant role in maintaining health and the immune system. Disruptions in the microbiome (dysbiosis) have been linked to various diseases, including thyroid diseases. Studies are needed to understand the causal relationship between dysbiosis and thyroid diseases. Autoimmune thyroid diseases (ATD) such as Hashimoto's thyroiditis and Graves' disease are common and their prevalence is increasing worldwide. While the exact cause of ATD remains unknown, research suggests a potential link between bacterial infections and ATD. Further investigation is required to determine whether bacterial infections can trigger ATD or influence treatment outcomes and prognosis. The gut microbiome has also been associated with thyroid cancer and benign nodules. More research is needed to understand the role of the microbiome in the development and progression of these conditions. 7

Patients with rheumatoid arthritis (RA) are at higher risk of developing specific comorbidities, including thyroid diseases, diabetes mellitus, primary hyperparathyroidism, vitamin B12 deficiency, and other autoimmune diseases. These comorbidities can negatively impact treatment outcomes in RA patients. Regular assessments of comorbidities should be considered to improve management and outcomes in RA patients. 13

Radioiodine has been used to treat hyperthyroidism for over 60 years. However, recent advancements in clinical practice have led to a better understanding of the risks associated with radioiodine treatment, particularly hypothyroidism, ophthalmopathy, and carcinogenesis. Accurate dosimetry remains challenging, but ongoing research is focused on improving treatment protocols and minimizing the risks. While the benefits of radioiodine treatment for subclinical hyperthyroidism are still under debate, it has become a widely accepted safe and effective therapy for benign, nontoxic goiters. The use of recombinant TSH shows promise in simplifying and improving radioiodine treatment for nontoxic goiters, but further research is needed in this area. 24

Radiation therapy for head and neck cancer can cause thyroid diseases as a sequela. Further research is needed to understand the influence of concomitant chemotherapy on radiation-induced thyroid complications. 19

Echotherapy, a non-invasive treatment using focused ultrasound, is gaining importance in treating thyroid diseases. Studies have shown significant volume reductions and symptom improvements in patients with benign and symptomatic thyroid nodules after echotherapy. The treatment is well-tolerated and has a low risk profile, making it a viable alternative to surgery. 2

The role of selenium in treating thyroid diseases is unclear, and more research is needed to determine its relevant indications.

Phytotherapy can be a promising option for treating hyperplastic thyroid diseases, aiming to stop nodule growth, compensate for hypothyroidism, and normalize thyroid size. Polentilla alba, a plant-based drug, has shown efficacy in monotherapy and combined conservative therapy for benign euthyroid goiters. It also demonstrates effectiveness in treating toxic and hypothyroid goiters. 18

While radioiodine (¹³¹I) therapy is a safe and effective treatment for benign thyroid diseases, long-term follow-up studies have reported occasional cases of malignant thyroid lesions. More research is required to understand the potential risks associated with radioiodine therapy. 1

Endoscopic thyroidectomy via the oral vestibular approach (ETOVA) and areola approach (ETAA) offer minimally invasive alternatives to traditional surgical techniques. These methods have shown promising results in terms of feasibility, safety, and cosmetic outcomes. 15

Gender-specific differences in the diagnosis and treatment of nontoxic thyroid nodules have been observed in Germany. 9

The management of thyroid diseases during pregnancy requires careful consideration due to the potential adverse effects on both the mother and fetus. While universal screening for thyroid diseases during pregnancy is not currently supported by strong evidence, guidelines have been established for high-risk individuals. Iodine prophylaxis should be implemented systematically for women during pregnancy. 16

Abnormalities in DNA methylation patterns in lymphocytes have been linked to autoimmune disorders. Studies examining DNA methylation changes after treatment for autoimmune thyroid diseases may contribute to a better understanding of the disease's pathogenesis and the development of new therapies. 14

Thyroid resections are common surgical procedures, with both hemithyroidectomy and thyroidectomy routinely performed for benign thyroid diseases. The extent of the resection directly influences the risk of postoperative complications, underscoring the importance of carefully evaluating the indications for each surgical approach. 12

Radiation safety is critical when using radioiodine therapy for thyroid diseases. The American Thyroid Association has developed recommendations to ensure the safety of patients, family members, and the public. Medical professionals should adhere to these recommendations to minimize the risks associated with radioiodine treatment. 20

Thyroid surgery in elderly patients requires careful consideration due to the increased risk of complications associated with age-related factors. While surgical procedures are generally considered more hazardous in older patients, advancements in surgical techniques and management protocols have improved safety outcomes. 22

Pediatric patients treated for brain tumors have a higher risk of developing thyroid dysfunction following treatment. 8

High-intensity focused ultrasound (HIFU) ablation is a promising non-invasive treatment option for benign thyroid nodules. Current evidence suggests that HIFU offers short- to medium-term outcomes comparable to established ablation techniques like radiofrequency and laser ablation. HIFU's non-invasive nature, with no need for needle insertion, makes it an attractive alternative to surgery. However, while HIFU has a lower risk profile, it is not without risks. Future research is needed to expand the current indications for HIFU treatment and enhance energy delivery. HIFU shows potential for treating relapsing Graves' disease and papillary microcarcinoma. Additionally, its role in mediating immune responses and synergistic effects with immunotherapy holds promise for combating metastatic cancers. 10

While radioiodine therapy has been used for over 70 years, there is no universally accepted standard for pretherapeutic dosimetry to optimize individual treatment activities. Further research is needed to standardize approaches for pretherapeutic activity calculation to ensure optimal treatment outcomes and minimize risks. 11

Accidental exposure to radioactive iodine (¹³¹I) during pregnancy can have detrimental effects on the developing fetus. The severity of radiation-induced effects depends on the gestational age at exposure, the absorbed radiation dose, and the resulting pathological conditions. Fetal death is a major concern during the early stages of pregnancy. Exposure during thyroid organogenesis (from 10 weeks onward) can lead to fetal thyroid ablation, malformations, growth restriction, and potential mental retardation. Even low doses of radiation can increase the risk of cancer later in life. Fetal and neonatal hypothyroidism due to in utero ¹³¹I exposure may require lifelong thyroxine replacement therapy and can lead to severe mental retardation if not diagnosed promptly. Clinicians treating women of childbearing age with ¹³¹I must be aware of the risks and take steps to prevent accidental exposure during pregnancy. In cases of accidental exposure, clinicians need to confirm the gestational age, evaluate the potential risks to the fetus by estimating the radiation dose, and discuss the management plan with the pregnant woman. 6

Radioiodine therapy remains a widely used and effective treatment for benign thyroid diseases. Ongoing research is focused on optimizing treatment protocols by considering individual variations in radiosensitivity and exploring methods to minimize side effects. Recent studies suggest that certain food products may help reduce or prevent potential side effects of radioiodine treatment. 17

The use of levothyroxine substitution and antithyroid drugs during pregnancy has shown a significant increase in recent years. This trend reflects a growing awareness of thyroid diseases and an emphasis on managing thyroid conditions during pregnancy. 5

Treatment summary

Treatment options for benign thyroid diseases include surgery, medications, radioiodine therapy, and echotherapy. 24 12 2

Radioiodine is commonly used to treat hyperthyroidism and benign thyroid diseases. However, it is contraindicated during pregnancy. 24 1 17 11 6

Selenium may have therapeutic potential for thyroid diseases, but further research is needed to confirm its effectiveness.

Phytotherapy can be a valuable treatment option for thyroid diseases. 18

The treatment of thyroid diseases in elderly patients requires careful consideration of age-related factors, including declining physical function and increased risk of complications. 22 4

Benefits and risks

Benefits summary

Treatment for thyroid diseases aims to normalize thyroid function, alleviate symptoms, and prevent complications. 13 10 4

Risks summary

Potential risks associated with thyroid disease treatment include hypothyroidism, adverse effects, and complications. 24 20 19 17 12 11 6

Radioiodine therapy during pregnancy can have serious consequences for the fetus. 6

Comparison of studies

Commonalities among studies

Many studies highlight the significant impact of thyroid diseases on patient health and the importance of appropriate treatment.

Differences among studies

The studies differ in terms of their focus on specific diseases, treatment methods, and research methodologies. Direct comparisons between results may not be possible due to these variations.

Consistency and discrepancies in results

There are both consistencies and discrepancies in the research findings. For instance, radioiodine therapy is an effective treatment for benign thyroid diseases, but long-term follow-up studies have reported rare occurrences of malignant thyroid lesions. 1

Considerations for real-world application

When applying research findings in real-life settings, it's crucial to consult with a healthcare professional to tailor treatment plans to individual patient needs. Self-treatment is dangerous and should be avoided.

Limitations of current research

Current research is limited by factors such as small sample sizes, short follow-up periods, and narrow focuses on specific diseases and treatments.

Future research directions

Future research should involve larger sample sizes, longer follow-up periods, and broader investigations encompassing a wider range of thyroid diseases and treatment options. The development of new therapies and improvements to existing treatments are essential.

Conclusion

Thyroid diseases can have a significant impact on health, emphasizing the importance of timely and appropriate treatment. Special considerations are crucial for managing thyroid diseases during pregnancy. Future research should focus on developing safer and more effective treatments while tailoring therapies to meet the individual needs of each patient.

Treatment list

Surgery, medication, radioiodine therapy, echotherapy, phytotherapy, selenium, high-intensity focused ultrasound (HIFU)