Lithium carbonate pre-treatment in 131-I therapy of hyperthyroidism

Płazińska, Maria Teresa; Królicki, Leszek; Bak, Marianna I

doi:10.5603/nmr.2011.0002

Cited by 14 publications

(13 citation statements)

References 13 publications

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“…Furthermore, a recent study has also shown that adjuvant lithium increased RAI uptake and stabilized thyroid hormones more quickly in patients with Graves' disease or toxic nodular disease receiving RAI. 20 However, this effect was confined to patients with a low baseline uptake of RAI, which therefore limits direct comparisons with the current study. We have demonstrated a small but statistically significant reduction in time to achieve cure with adjuvant lithium.…”

Section: Analysis Adjustmentsmentioning

confidence: 86%

Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease

Martin

Patel

Nijher

et al. 2012

Clinical Endocrinology

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SummaryContext Lithium increases iodine retention in the thyroid gland and inhibits thyroid hormone release. Although lithium has been reported to improve the efficacy of radioactive iodine (RAI) treatment in Graves' disease, its role as an adjunct to RAI treatment of hyperthyroidism, particularly in toxic nodular disease, remains contentious. Objective To assess whether adjuvant lithium increases the efficacy of a fixed dose RAI regimen in Graves' and toxic nodular hyperthyroid patients. Design and setting Retrospective cohort study in a tertiary referral centre. Two hundred and four hyperthyroid patients (163 Graves' disease, 26 toxic multinodular goitre and 15 solitary toxic thyroid adenoma). Intervention One hundred and three patients received RAI alone (median dose 558 MBq). One hundred and one patients received RAI (median dose 571 MBq) with adjuvant lithium (800 mg/day for 10 days). Main outcome measure Proportion of patients cured at any time over a 1-year period following RAI treatment. Cure was defined as sustained (two or more sequential time points) biochemical euthyroidism or hypothyroidism during the follow-up period.Results The likelihood of cure at any time was 60% greater in all hyperthyroid patients (Graves' plus toxic nodular disease) receiving adjuvant lithium (n = 204, P = 0·003). In patients with Graves' disease receiving RAI + lithium, there was a similar occurrence in cure (n = 163, P = 0·006). Cure was twice as likely in patients with toxic nodular (non-Graves') disease receiving RAI + lithium compared with RAI alone (n = 41, P = 0·01). Conclusions This study supports the use of adjuvant lithium to improve the efficacy of RAI in the treatment of Grave's disease and suggests a novel role in the management of toxic nodular (non-Graves') disease.

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Section: Analysis Adjustmentsmentioning

confidence: 86%

Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease

Martin

Patel

Nijher

et al. 2012

Clinical Endocrinology

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“…The recommended dose of lithium is 500 to 1500 mg/day, so that serum lithium levels are maintained between the ranges of 0.6-1.2 mmol/L (12,13). Lithium increases thyroid gland retention of iodine and allows the use of lower doses of 131 I, therefore, increases the efficacy of radioactive iodine therapy (14). The recommendations are to start lithium therapy 5 days before and to continue for 7 days after radioiodine therapy (15).…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Lithium and Radioiodine Therapy in the Treatment of Hyperthyroidism

Barud¹,

Ryczak²,

Biłan³

et al. 2014

tjem

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Intravenous contrast media used for coronary angiography are iodine-based and could induce thyroid gland dysfunction. We present the case of a 58-year-old woman with coronary artery disease who developed hyperthyroidism after percutaneus coronary intervention. Treatment with thiamazole induced agranulocytosis, complicated with severe tonsillitis. During recurrence of hyperthyroidism, after careful assessment of available methods of treatment, she was recommended to undergo radioiodine therapy (131 I). The patient received lithium carbonate as pretreatment. After 13 days of pre-treatment, patient received the therapeutic dose of 131 I. Neither thyrotoxicosis progression nor acute coronary syndrome occurred. After 3 weeks, her thyroid hormones were found to be within normal ranges. Lithium therapy could be used as an effective treatment in patients who developed serious side-effects due to previous treatment with thionamides.

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“…7,19 In fact Plazinska et al even went further to show that adjuvant lithium is able to increase thyroidal radioiodine uptake in patients with a low baseline RAIU, that is RAIU less than 30. 21 Zha et al also found that in patients treated with adjunct lithium during RAI therapy the mean radiation absorbed dose rate in the anterior neck was significantly higher than that with RAI alone. 19 Adjunct lithium can increase radiation dose to the thyroid by an average of 39%.…”

Section: Time To Curementioning

confidence: 96%

“…22 This finding is very significant because of the immense benefits of early control of hyperthyroidism, especially in the elderly and side effects can be attributed to a considerably lower dose regimen and shorter period over which it was administered compared with previous studies. 11,20,21 Even in a previous study where 900 mg of adjuvant lithium per day was given for 12 days, occurrence of side effects was insignificant to limit its usage. 11 Hence with our lower dose it is safe to assume that these patients should remain free of adverse effects.…”

Section: Time To Curementioning

confidence: 99%

Lithium-enhanced radioactive iodine ablation of hyperthyroid patients

Hammond

Vangu

2016

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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Objective: The objective of this study was to compare the effect of adjuvant lithium therapy on the efficacy of radioactive iodine therapy in hyperthyroidism. Methods: This was a prospective simple randomised comparative, experimental cohort study of hyperthyroid patients for radioactive iodine (RAI) ablation therapy. A total of 163 of the 185 hyperthyroid patients recruited completed the study. Cure was defined by achievement of euthyroidism or hypothyroidism. Results: From of total of 163 patients, 75 received RAI alone and 88 received RAI with lithium. Those who received RAI with adjuvant lithium showed a higher cure rate (78.4%) compared with those who received RAI only (68.1%) (p = 0.002). At one month post RAI therapy, 27.4% of patients who received RAI with adjuvant therapy were cured. This finding showed a trend of being significant compared with just 14.5% cure rate in the group of patients who received RAI alone (p = 0.08). This is an indication of a faster cure rate for patients receiving RAI with lithium. Difference in mean T4 concentration at three months between RAI only (17.67 pmol/l) and RAI with lithium (11.55 pmol/l) was significant with a small size effect (U = 2328.5, Z = -2.700, p = 0.007, r = 0.01). A significant drop in T4 concentrations was observed between the baseline and one-month visit with small effect size (p = 0.001, r = 0.287) in patients who received both RAI and lithium. Conclusion: Adjuvant lithium therapy increases the efficacy of radioactive iodine treatment in hyperthyroidism by increasing overall cure rate and also shortening the time to cure.

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Lithium carbonate pre-treatment in 131-I therapy of hyperthyroidism

Cited by 14 publications

References 13 publications

Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease

Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease

Beneficial Effects of Lithium and Radioiodine Therapy in the Treatment of Hyperthyroidism

Lithium-enhanced radioactive iodine ablation of hyperthyroid patients

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