JBiSE  Vol.6 No.7 D , July 2013
Lithium carbonate plus 131I in the treatment of Graves’ hyperthyroidism
ABSTRACT
Aims: Effectiveness of radioiodine for Graves’ hyperthyroidism (GD) depends on its intrathyroidal persistence, which could be enhanced by lithium by blocking the release of organic iodine and thyroid hormone from the thyroid gland. The present aim focused on the effect of the addition of lithium carbonate to 131I therapy in patients with GD. Methods: 100 consecutive patients with GD were randomly assigned to two groups: group (A) patients treated with 131I and group (B) patients treated with 131I plus lithium carbonate. Patients in B group were treated with a dose of 0.5 g per day (2 × 0.25 g) of lithium carbonate for half a month before and after the administration of 131I. Thyroid weight was estimated by ultrasonography and careful palpation of the thyroid. Radiation absorbed dose rate in the front of the neck was measured on days 1530 and 45 after the administration of 131I. Serum concentrations of thyroidstimulation hormone (TSH), fee tri-iodothyrosine (T3) and free thyroxine (T4) were tested on days 30, 45, 90, 180 before and after treatment. Results: After RIT, radiation absorbed dose rate in the front of neck gradually decreased as time went on (p < 0.01), all of which were significantly higher in B group than those in A group (p < 0.01). Of all different time periods before and after treatment, the mean serum TSH of the two groups was below the normal range without significant difference (p > 0.05), free T3 and free T4 values in both groups rose significantly one month after treatment (all p < 0.01) , then decreased into the normal ranges. Over 30 d of treatment, the values in B group patients were much lower than those in A group (all p < 0.01). No significance was found in other time periods (all p > 0.05). Cure rate of hyperthyroidism was achieved in 36 of the 50 patients (72%) treated with 131I alone and in 38 of the 50 patients (76%) treated with 131I plus lithium. Conclusion: We suggest that for patients withdrawing of ATD and those with short effective half-time, as well as those intolerant or invalid, the short term addition of lithium to 131I allows for a better control of thyrotoxia and the completeness of treatment.

Cite this paper
Zha, J. , Jiang, Y. , Xu, Y. , Lin, Q. , Huang, C. and Jiang, T. (2013) Lithium carbonate plus 131I in the treatment of Graves’ hyperthyroidism. Journal of Biomedical Science and Engineering, 6, 1-5. doi: 10.4236/jbise.2013.67A4001.
References
[1]   Akin, F., Yaylali, G.F. and Bastemir, M. (2008) The use of lithium carbonate in the preparation for definitive therapy in hyperthyroid patients. Medical Principles and Practice, 2, 167-170. doi:10.1159/000112975

[2]   Bogazzi, F., Bartalena, L., Brogioni, S., et al. (1999) Comparison of radioiodine with radioiodine plus lithium in the treatment of Graves’ hyperthyroidism. The Journal of Clinical Endocrinology & Metabolism, 2, 499-503. doi:10.1210/jc.84.2.499

[3]   Bal, C.S., Kumar, A. and Pandey, R.M. (2002) A randomized controlled trial to evaluate the adjuvant effect of lithium on radioiodine treatment of hyperthyroidism. Thyroid, 5, 399-405. doi:10.1089/105072502760043486

[4]   Dunkelmann, S., Künstner, H., Nabavi, E., et al. (2006) Lithium as an adjunct to radioiodine therapy in Graves’ disease for prolonging the intrathyroidal effective halflife of radioiodine. Useful or not? Nuklearmedizin, 5, 213-218.

[5]   Bogazzi, F., Bartalena, L., Campomori, A., et al. (2002) Treatment with lithium prevents serum thyroid hormone increase after thionamide withdrawal and radioiodine therapy in patients with Graves’ disease. The Journal of Clinical Endocrinology & Metabolism, 10, 4490-4495. doi:10.1210/jc.2002-020580

[6]   Kirov, G., Tredget, J., John, R., et al. (2005) A cross-sectional and a prospective study of thyroid disorders in lithium-treated patients. Journal of Affective Disorders, 87, 313-317.

[7]   Mijnhout, G.S. and Franken, A.A. (2008) Antithyroid drug regimens before and after 131I-therapy for hyperthyroidism: Evidence-based? Netherlands Journal of Medicine, 6, 238-241.

[8]   Dunkelmann, S., Kuenstner, H., Nabavi, E., et al. (2007) Change in the intrathyroidal kinetics of radioiodine under continued and discontinued antithyroid medication in Graves’disease. European Journal of Nuclear Medicine and Molecular Imaging, 2, 228-236. doi:10.1007/s00259-006-0234-z

[9]   Burch, H.B., Solomon, L., Cooper, D.S., et al. (2001) The effect of antithyroid drug pretreatment on acute changes in thyroid hormone levels after (131)I ablation for Graves’ disease. The Journal of Clinical Endocrinology & Metabolism, 7, 3016-3021. doi:10.1210/jc.86.7.3016

[10]   Ng, Y.W., Tiu, S.C., Choi, K.L., et al. (2006) Use of lithium in the treatment of thyrotoxicosis. Hong Kong Medical Journal, 4, 254-259.

[11]   Hoogenberg, K., Beentjes, J.A., Piers, D.A. (1998) Lithium as an adjunct to radioactive iodine in treatment-resistant Graves thyrotoxicosis. Annals of Internal Medicine, 8, 670. doi:10.7326/0003-4819-129-8-199810150-00025

[12]   Barbaro, D., Grosso, M., Boni, G., et al. (2010) Recombinant hurman TSH and ablation of post-surgical thyroid remnants in differentiated thyroid cancer the effect of pre-treatment with furosemide and furosemide plus lithium. European Journal of Nuclear Medicine and Molecular Imaging, 2, 242-249. doi:10.1007/s00259-009-1254-2

 
 
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