Kessler Lynn, Palla Jyothsna, Baru Joshua S, Onyenwenyi Chioma, George Amrutha M, Lucas Brian P
Division of Endocrinology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois.
Division of Hospital Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois.
Endocr Pract. 2014 Jul;20(7):737-45. doi: 10.4158/EP13504.RA.
Radioactive iodine (RAI) is commonly used in the treatment of hyperthyroidism but is not uniformly successful. Lithium increases thyroidal iodine retention without reducing iodide uptake, increasing the radiation dose to the thyroid when administered with RAI. Although these actions suggest that adjuvant lithium may increase the efficacy of RAI, its role as an adjunct to RAI remains contentious.
To evaluate the safety and efficacy of adding lithium to RAI to treat hyperthyroidism.
Relevant studies were identified by a search of Medline and the Cochrane Central Register of Controlled Trials. To be included, a study had to be a controlled trial comparing the effect of RAI alone to RAI with lithium in the treatment of hyperthyroidism. Relevant data were extracted and meta-analyses were performed.
Of the 75 identified studies, 6 met the inclusion criteria; 4 of these studies were interventional and 2 were observational trials. Meta-analysis of the observational trials (N = 851), both of which were retrospective cohort studies, showed significant improvement in the primary outcome (i.e., cure rate) with adjunctive lithium (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.24 to 2.96). The combined interventional trials (N = 485) also showed an improvement in cure rate, but the difference did not reach statistical significance (OR, 1.28; 95% CI, 0.85 to 1.91). Adjunctive lithium reduced time to cure and blunted thyroid hormone excursions after RAI. Lithium-related side effects were infrequent and usually mild.
The observational trials demonstrated significant improvement in the cure rate of hyperthyroidism when lithium is added to RAI. The improvements shown in the interventional trials did not reach statistical significance due to the effect of a single, large negative trial.
放射性碘（RAI）常用于治疗甲状腺功能亢进，但并非总能取得一致成功。锂可增加甲状腺对碘的潴留，而不降低碘摄取，与RAI合用时可增加甲状腺的辐射剂量。尽管这些作用提示辅助使用锂可能会提高RAI的疗效，但其作为RAI辅助治疗的作用仍存在争议。
评估在RAI治疗甲状腺功能亢进时加用锂的安全性和疗效。
通过检索Medline和Cochrane对照试验中心注册库来确定相关研究。纳入的研究必须是比较单独使用RAI与RAI联合锂治疗甲状腺功能亢进效果的对照试验。提取相关数据并进行荟萃分析。
在75项已识别的研究中，6项符合纳入标准；其中4项研究为干预性研究，2项为观察性试验。对观察性试验（N = 851，均为回顾性队列研究）进行荟萃分析显示，辅助使用锂可使主要结局（即治愈率）有显著改善（优势比[OR]，1.92；95%置信区间[CI]，1.24至2.96）。联合干预性试验（N = 485）也显示治愈率有所提高，但差异未达到统计学意义（OR，1.28；95% CI，0.85至1.91）。辅助使用锂缩短了治愈时间，并减轻了RAI后甲状腺激素的波动。与锂相关的副作用很少见，且通常较轻。
观察性试验表明，在RAI中加用锂可显著提高甲状腺功能亢进的治愈率。由于一项大型阴性试验的影响，干预性试验中显示的改善未达到统计学意义。
