Clinical comparative efficacy and therapeutic strategies for the Hashimoto's thyroiditis: A systematic review and network meta-analysis

Abstract

Ethnopharmacological relevance: Vitamin D (VD), selenium preparations (Se), and thyroid hormone replacement therapy are commonly used to treat Hashimoto thyroiditis (HT). Increasing evidence suggests that traditional Chinese medicine (TCM) is an effective therapeutic strategy in the treatment of HT.

Aim of the study: This study aimed to investigate the efficacy and safety of commonly-used drugs for HT.

Materials and methods: A literature search was performed using PubMed, Web of Science, Cochrane Library, EMBASE, Chinese China National Knowledge Infrastructure (CNKI), Clinical Trial Registry (Chi CTR), China Science and Technology Journal Database (the VIP), Wanfang Database, and China Chinese Biomedical Database (CBM) from January 1, 2003, to December 31, 2022. The outcomes included TPOAb, TgAb, TSH, FT3, FT4, and adverse events. Our study was registered in PROSPERO (CRD42023449705).

Results: Sixty trials and 4719 participants were included, comparing 16 treatments: VD, Se, LT-4, Se + LT-4, HM, placebo + LT-4, HM + LT-4, Se + myolnositol, Se + VD, HM + Se, mannan peptide, LT-4+prednisone, Methimazole, Methimazole + HM, Tapazole + Propranolol, and placebo. We found that Chinese herbal medicine has significant effect vs. LT-4 [MD 0.10, 95 % confidence interval 0.02 to 0.50]) and LT-4+placebo [MD 0.10, 95 % confidence interval 0.01 to 0.77]) in reducing TPOAb. Although receiving LT-4+prednisone was not statistically significant, the treatment ranking showed that this combination therapy had the highest probability of reducing TPOAb levels (72.8 %). In addition, the effect of Se plus LT-4 was not statistically significant; however, the treatment ranking showed that this combination therapy had the highest probability (78.6 %) of reducing TgAb levels, followed by HM (64.0 %). Reports on side effects have mainly focused on the digestive and cardiovascular systems.

Conclusion: Our analyses showed that HM alone or in combination with other treatments for patients with HT can improve the side effects of other drugs, enhance efficacy, and maybe the most effective option for treating HT. However, there still need further verified using high-quality evidence.

Keywords: Hashimoto's thyroiditis; Network meta-analysis; Oral medications; TPOAb; TgAb.

Graphical abstract

Fig. 1

Summary of trial identification and selection.

Fig. 2

Risk of bias summary and risk of bias graph.

Fig. 3

Network meta-analysis of available comparisons in TPOAb.

Fig. 4

Legend relative effects size of efficacy at TPOAb according to NMA. Numbers in the green boxes are the values of SUCRA, which represents the rank of treatment in TPOAb. Significant pairwise comparisons with control treatment are highlighted in orange.

Fig. 5

Ranking of treatment strategies based on the probability in terms of reducing TPOAb.

Fig. 6

Comparison-specific funnel chart in terms of reducing TPOAb. A, placebo; B, VD; C, Se; D, LT-4; E, Se + LT-4; F, HM; G, placebo + LT-4; H, HM + LT-4; I, Se + myolnositol; J, Se + VD; K, HM + Se; L, Mannan peptide; M, LT-4+prednisone; N, Methimazole; O, Methimazole + HM; P, Tapazole + Propranolol.

Fig. 7

Network meta-analysis of available comparisons in TgAb.

Fig. 8

Legend relative effects size of efficacy at TgAb according to NMA. Numbers in the green boxes are the SUCRA values, which represent the treatment rank in TgAb.

Fig. 9

Ranking of treatment strategies based on the probability in terms of reducing TgAb.

Fig. 10

Comparison-specific funnel chart in terms of reducing TgAb. A, placebo; B, VD; C, Se; D, LT-4; E, Se + LT-4; F, HM; G, placebo + LT-4; H, HM + LT-4; I, Se + myolnositol; J, Se + VD; K, HM + Se; L, Mannan peptide; M, LT-4+prednisone; N, Methimazole; O, Methimazole + HM; P, Tapazole + Propranolol.

Fig. 11

The treatment strategies in different period of HT.

Fig. 12

The frequency adverse reactions in different treatments.