Quality of Life Following Thermal Ablation of Benign Thyroid Nodules: A Systematic Review and Meta-Analysis

Abstract

Background:

Benign thyroid nodules (BTNs) may cause significant compressive symptoms and cosmetic concerns. Thermal ablation has emerged as an alternative to resection, but its impact on quality of life (QOL) has not been thoroughly evaluated. Our objective was to evaluate the existing literature for QOL outcomes, as measured by validated instruments, after BTN thermal ablation.

Methods:

MEDLINE, Embase, Scopus, EBSCO, and ProQuest Dissertations & Theses Global were searched through December 8, 2025. Studies in English reporting QOL using validated instruments for thermal ablation of BTNs were included. Three reviewers completed article screening, data extraction, and risk of bias assessments (RoBANS 2 and Cochrane Collaboration’s tool). Pooled mean differences (MDs) in QOL were calculated for Thyroid-Related Patient-Reported Outcome (ThyPRO) scales using a random-effects model and the inverse-variance approach; pooling was not possible for other instruments due to sparse utilization across varied time points across studies.

Results:

Of the 72 articles screened, the review included 13, and the meta-analysis included 4. The included studies were randomized controlled trials (3), cohort studies (3), or pre/post studies (7). The baseline sample sizes ranged from 14 to 120. Ablation techniques included radiofrequency (7 studies), laser (3), and microwave (3). QOL instruments included two thyroid-specific (ThyPRO: 7 studies, Patient-Reported Outcome Measure for Parathyroid and Thyroid disease, or PROMPT: 1), one dysphagia-specific (Swallowing Quality of Life tool, or SWAL-QOL: 1), and three generic (2 Short Form scales, SF-12: 2 and SF-36: 4, EuroQol-5 dimension-3 level scale (EQ-5D-3L): 1) instruments. QOL improvements generally became apparent between three and six months; long-term durability was variable. Improvements in overall QOL (8 of 9 studies) were more consistent than improvements in compressive QOL (4 of 5 studies) or cosmetic QOL (2 of 4 studies). ThyPRO domain MDs statistically improved for most scales, although the consistency of improvement across time points varied. MDs exceeded minimal important changes (MICs) for goiter (all four time points); anxiety (≤1 month only); cognition, depressivity, and emotional susceptibility (≤1 month and 12 months only); and cosmetic, hyperthyroid, and eye domains (12 months only).

Conclusions:

QOL generally improves between three and six months after BTN ablation, although variability is seen across thyroid-specific QOL domains. Study comparability was limited by inconsistent numeric reporting and heterogenous follow-up intervals. Future research should utilize thyroid-specific instruments, extend follow-up beyond one year, include inferential within-subject repeated measures analyses, and contextualize the clinical meaningfulness of QOL changes using MICs.