Lithium carbonate plus ¹³¹I in the treatment of Graves’ hyperthyroidism

Jinshun Zha, Yan Jiang, Yuan Xu, Qinxiu Lin, Chunling Huang, Tingyin Jiang

Department of Library, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Nuclear Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Pediatrics, Jinjiang Maternal and Child Health Hospital, Quanzhou, China.

DOI: 10.4236/jbise.2013.67A4001                

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.

Keywords

Lithium Carbonate; Iodine Radioisotopes; Graves’ Hyperthyroidism; Chemotherapy; Adjuvant

Conflicts of Interest

The authors declare no conflicts of interest.

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