Mortality Risks Associated with Antithyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic Review and Network Meta-Analysis
Authors' conclusion
In patients with hyperthyroidism, surgery was associated with significantly decreased risks of all-cause mortality and cardiovascular mortality compared with ATD and RAI. Risks of MACE and cancer mortality did not differ by type of hyperthyroidism treatment.
Study context
- Population
- Patients with hyperthyroidism treated with antithyroid drugs (ATD), radioactive iodine (RAI) or surgery; PubMed, EMBASE, Web of Science, Cochrane Library to March 7, 2025
- Participants
- 192,208 patients12 observational studies
- Comparison
- Surgery vs ATD vs RAI for hyperthyroidism
- ATDn = 142,622
- RAIn = 19,303
- Surgeryn = 10,360
- Outcome
- All-cause mortality, CV mortality, MACE and cancer mortality
Methodological detailsrandom-effects model, PRISMA-NMA
- Random-effects model
- PRISMA-NMA
Pooled result
As reported in the abstract
All-cause mortality
Pooled hazard ratio (CI)P value
Surgeryvs ATD
0.58(0.45–0.75)
P < 0.0001Surgeryvs RAI
0.68(0.56–0.84)
P = 0.0004Further pooled results
| Outcome | Pooled HR (CI) | P value | |
|---|---|---|---|
| CV mortalitySurgeryvs ATD | 0.43 (0.19–0.98) | P = 0.0445 | |
| CV mortalitySurgeryvs RAI | 0.55 (0.33–0.93) | P = 0.0269 | |
| 0.20.5125Pooled hazard ratio (log scale) |
Major adverse cardiovascular events (MACE) and cancer mortality
- No significant differences in MACE or cancer mortality across treatment groups
Original publication
Mortality Risks Associated with Antithyroid Drugs, Radioactive Iodine, and Surgery for Hyperthyroidism: A Systematic Review and Network Meta-Analysis. Thyroid. Published 1 September 2025. doi:10.
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