Department of Endocrinology and Metabolism, and Epidemiology and Biostatistics Unit (G.R.), Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy.
J Clin Endocrinol Metab. 2010 Jan;95(1):201-8. doi: 10.1210/jc.2009-1655. Epub 2009 Nov 11.
Radioactive iodine (RAI) is a common therapy for hyperthyroidism due to Graves' disease. A small but significant proportion of patients have recurrence of hyperthyroidism after RAI therapy. Lithium might increase RAI effectiveness by increasing RAI retention in the thyroid. However, whether lithium favorably affects the long-term outcome of RAI therapy is still a matter of argument.
The objective of the study was to compare the efficacy of RAI given with or without concomitant lithium treatment.
This was a retrospective cohort study.
The study was conducted at a tertiary university center.
Six hundred fifty-one patients with newly diagnosed Graves' disease participated in the study.
Two hundred ninety-eight patients were treated with RAI plus lithium (900 mg/d for 12 d) and 353 with RAI alone.
Proportion of cured patients and time to achieve cure of hyperthyroidism during 1 yr of follow-up was measured.
PATIENTS treated with RAI plus lithium had a higher cure rate (91.0%) than those treated with RAI alone (85.0%, P = 0.030). In addition, patients treated with RAI plus lithium were cured more rapidly (median 60 d) than those treated with RAI alone (median 90 d, P = 0.000). Treatment with lithium prevented the serum free T(4) increase after methimazole withdrawal and RAI therapy. Side effects after RAI therapy occurred in a subset of patients and were mild, transient, and without differences in the two groups.
RAI combined with lithium is safe and more effective than RAI alone in the cure of hyperthyroidism due to Graves' disease.
放射性碘（RAI）是治疗格雷夫斯病引起的甲状腺功能亢进症的常用方法。一小部分患者在接受 RAI 治疗后会复发甲状腺功能亢进症。锂可能通过增加甲状腺对 RAI 的摄取来提高 RAI 的疗效。然而，锂是否能改善 RAI 治疗的长期效果仍存在争议。
本研究旨在比较 RAI 联合或不联合锂治疗的疗效。
这是一项回顾性队列研究。
研究在一家三级大学中心进行。
651 例新诊断的格雷夫斯病患者参与了这项研究。
298 例患者接受 RAI 加锂（12 天内每天 900 毫克）治疗，353 例患者仅接受 RAI 治疗。
在 1 年的随访期间，测量治愈患者的比例和达到甲状腺功能亢进症治愈的时间。
接受 RAI 加锂治疗的患者治愈率（91.0%）高于仅接受 RAI 治疗的患者（85.0%，P = 0.030）。此外，接受 RAI 加锂治疗的患者比仅接受 RAI 治疗的患者更快治愈（中位数 60 天 vs. 中位数 90 天，P = 0.000）。锂治疗可预防甲巯咪唑停药和 RAI 治疗后血清游离 T4 的增加。RAI 治疗后，部分患者出现轻微、短暂的不良反应，但两组间无差异。
RAI 联合锂治疗格雷夫斯病引起的甲状腺功能亢进症比单独使用 RAI 更安全、更有效。
