Treatment with Lithium Prevents Serum Thyroid Hormone Increase after Thionamide Withdrawal and Radioiodine Therapy in Patients with Graves’ Disease

Bogazzi, Fausto; Bartalena, Luigi; Campomori, Alberto; Brogioni, Sandra; Traino, Claudio; Martino, Fabio De; Rossi, Giuseppe; Lippi, Francesco; Pinchera, Aldo; Martino, Enio

doi:10.1210/jc.2002-020580

Cited by 71 publications

(52 citation statements)

References 26 publications

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“…The improved efficacy of RAI + lithium in patients with toxic nodular (non-Graves') disease is of particular interest, because the previous studies of adjuvant lithium in the RAI treatment of hyperthyroidism have focused on patients with Graves' disease. 13,14,17 A large, randomized controlled study of the effects of adjuvant lithium on cure following RAI treatment of hyperthyroid patients secondary to uninodular or multinodular disease may further elucidate the role of lithium in this patient group. The observed cure rate (83·5%) in the RAI alone group (Graves' and non-Graves' disease) is consistent with a previously published study of the efficacy of RAI using a similar RAI dose.…”

Section: Analysis Adjustmentsmentioning

confidence: 99%

“…8,11 Furthermore, because of its inhibitory effects on thyroid hormone release, 11,12 lithium may attenuate the initial rise in circulating thyroid hormones that occurs following RAI administration. [13][14][15] However, to date, it has not been clearly demonstrated that adjuvant lithium actually improves RAI efficacy. 16,17 A large, randomized, controlled study of patients with Graves' hyperthyroidism or toxic nodular hyperthyroidism concluded that adjuvant lithium (900 mg per day for 3 weeks starting on the day of RAI treatment) did not influence overall cure following RAI.…”

Section: Introductionmentioning

confidence: 99%

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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: 99%

Section: Introductionmentioning

confidence: 99%

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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“…As taxas de remissão do hipertireoidismo após administração do 131 I, em doses variando entre 7 a 20 mCi, são de 59 a 100% (16,20,(25)(26)(27)(28)(29). Até cerca de 40% dos pacientes podem requerer mais de uma dose do 131 I para debelar o hipertireoidismo, mas somente poucos necessitarão de três ou mais doses.…”

Section: Discussionunclassified

Avaliação da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doença de graves

Canadas

Vilar²,

Moura³

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOAs opções terapêuticas para a hipertireoidismo da doença de Graves são as drogas antitireoidianas, a cirurgia e o radioiodo, porém nenhuma delas é considerada ideal pois não atuam diretamente na etiopatogênese da doença. O radioiodo vem sendo cada vez mais utilizado como primeira escolha, sendo um tratamento definitivo, seguro e de fácil administração. Há autores que preferem doses mais altas para induzir deliberadamente o hipotireoidismo, enquanto outros recomendam doses mais baixas que, a curto prazo, implicam menor incidência de hipotireoidismo e maior de eutireoidismo. Não há consenso sobre o melhor esquema de doses fixas a ser utilizado, sendo esse o principal enfoque deste estudo, no qual comparamos doses de 10 e 15 mCi. Dos 164 pacientes analisados, 61 (37,2%) foram submetidos a 10 mCi e 103 (62,8%), a 15 mCi de 131 I. Na análise longitudinal, observou-se que a remissão do hipertireoidismo foi estatisticamente diferente no sexto mês (p < 0,001), sendo maior no grupo em que foi empregada a dose de 15 mCi. Contudo, foi semelhante nos dois grupos após 12 e 24 meses. É possível concluir que doses fixas de 10 e 15 mCi promovem semelhante remissão do hipertireoidismo após 12 meses de tratamento. A remissão do hipertireoidismo não teve associação com idade, sexo ou uso prévio de drogas antitireoidianas. The treatment options for the hyperthyroidism of Graves' disease are antithyroid drugs, surgery and radioiodine, none of which is considered ideal, as they do not act directly on the etiopathogenesis of the disease. Radioiodine has been increasingly used as the treatment of choice because it is a safe and definitive therapy whose administration is very easy. Some authors prefer to administer higher doses in order to deliberately induce hypothyroidism, while others recommend lower doses that result in a lower incidence of hypothyroidism and a greater incidence of euthyroidism. There is no consensus for the optimal regimen of fixed doses to be used and this is the main focus of the present study, where doses of 10 and 15 mCi of 131 I were compared. Among the 164 patients analyzed, 61 (37.2%) were submitted to 10 mCi and 103 (62.8%) to 15 mCi. In the longitudinal analysis it was observed that remission of the hyperthyroidism was statistically different in the sixth month (p < 0.001), being higher in the group that used the dose of 15 mCi, but similar in both groups at 12 and 24 months. It may be concluded that the administration of fixed doses of 10 and 15 mCi of 131 I brought about a similar remission of the hyperthyroidism after 12 months of treatment. Moreover, the remission rate of the hyperthyroidism had no association with age, sex or previous therapy with antithyroid drugs.

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“…It has been estimated that lithium can prolong the effective half-life of iodine-131 by 50%, which can lower the administered dose while maintaining the effective dose [41]. In addition, the concomitant administration of lithium with iodine-131 can prevent the transient increase in serum T4 concentrations following radioiodine therapy as can result in a radioiodine-damaged thyroid gland [42]. This effect can make iodine-131 therapy safer in certain patient populations, such as elderly patients and those with cardiovascular disease [43], by preventing a thyroid storm.…”

Section: Radioactive Iodine-131 Therapy Adjunctmentioning

confidence: 99%

Lithium Therapy and Thyroid Disorders

Thut¹,

Cheng

2013

Thyroid Disorders Ther

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Treatment with Lithium Prevents Serum Thyroid Hormone Increase after Thionamide Withdrawal and Radioiodine Therapy in Patients with Graves’ Disease

Cited by 71 publications

References 26 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

Avaliação da radioiodoterapia com doses fixas de 10 e 15 mCi em pacientes com doença de graves

Lithium Therapy and Thyroid Disorders

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