Systematic Review In Evaluating Thyroid Diseases' Diagnosis And Treatment

Objectives:To evaluate diagnostic tests and prognosis study for thyroid diseases by Meta-analysis. Evaluating the accuracy of the diagnosis test in thyroid nodules and examining whether thyroxine treatment have effect on serum lipid levels in patients with subclinical hypothyroidism by Meta-analysis,then assessing their clinical value.Methods:Pubmed database and CNKI database were searched for the related articles of in English and Chinese respectively, concerning diagnostic tests of thyroid nodules and randomized controlled trials about the effect of thyroxine on subclinical hypothyroidism patients'serum lipid levels , hand-search was also included.Evaluating the methodological quality of all included studies,and extracted data and analyzed data according to the requirements of Cochrane systematic review .Results: Data were combined by Metadisc software in thyroid nodules diagnostic test.There were 8810 specimens in diagnosing thyroid nodules using conventional FNAB,with pooled weighted sensitivity 84.9%,pooled weighted specificity 76.3%, and the area under SROC was 0.9194. There were 2393 specimens in diagnosing thyroid nodules using US- FNAB,with pooled weighted sensitivity 84.0%,pooled weighted specificity 80.8%, and the area under SROC was 0.9356. There were 2712 specimens in diagnosing thyroid nodules using Ultrasound,with pooled weighted sensitivity 80.8%,pooled weighted specificity 91.6%, and the area under SROC was 0.9227.Data were combined by Revman4.2 software in thyroxine replacement treatment.The pooled effect sizes of TC,TG,HDL-C,LDL-C,ApoA,ApoB,Lp(a) were: -0.39(-0.71,-0.07),-0.02(-0.07,0.04),-0.02(-0.06,0.03),-0.22(-0.31,-0.12),-0.08(-0.11,-0.06),-0.05(-0.08,-0.02),-0.38(-2.41,1.64).The analysis results shows thyroxine treatment is significant effective on TC,LDL-C,ApoA,ApoB,but less significant effective on TG,HDL-C,Lp(a).Conclusion: Meta-analysis in thyroid nodules diagnostic test demonstrates that FNAB,US-FNA and Ultrasound all have high accuracy in the diagnosis of thyroid nodules.The sensitivity of FNAB and US-FNA were higher ,it can reduce missed diagnosis.The specificity of Ultrasound were higher,it can reduce misdiagnosis. Meta-analysis of prognosis study demonstrates that thyroxine replacement treatment is effective on serum lipid levels in patients with subclinical hypothyroidism.It can reduce prevalence of artherosclerosis and coronary heart disease in patients with subclinical hypothyroidism.