Sekulić Vladan, Rajić Milena, Vlajković Marina, Ilić Slobodan, Stević Miloš, Kojić Marko
Center of Nuclear Medicine and Clinical Center of Niš, University of Niš, Faculty of Medicine, bul. Dr Zoran Đinđić 48, 18000, Niš, Serbia.
Ann Nucl Med. 2017 Dec;31(10):744-751. doi: 10.1007/s12149-017-1206-z. Epub 2017 Sep 11.
The outcome of radioiodine therapy (RIT) in Graves' hyperthyroidism (GH) mainly depends on radioiodine (I) uptake and the effective half-life of I in the gland. Studies have shown that lithium carbonate (LiCO) enhances the I half-life and increases the applied thyroid radiation dose without affecting the thyroid I uptake. We investigated the effect of short-term treatment with LiCO on the outcome of RIT in patients with long-lasting GH, its influence on the thyroid hormones levels 7 days after RIT, and possible side effects.
Study prospectively included 30 patients treated with LiCO and I (RI-Li group) and 30 patients only with I (RI group). Treatment with LiCO (900 mg/day) started 1 day before RIT and continued 6 days after. Anti-thyroid drugs withdrawal was 7 days before RIT. Patients were followed up for 12 months. We defined a success of RIT as euthyroidism or hypothyroidism, and a failure as persistent hyperthyroidism.
In RI-Li group, a serum level of Li was 0.571 ± 0.156 mmol/l before RIT. Serum levels of TT and FT increased while TSH decreased only in RI group 7 days after RIT. No toxic effects were noticed during LiCO treatment. After 12 months, a success of RIT was 73.3% in RI and 90.0% in RI-Li group (P < 0.01). Hypothyroidism was achieved faster in RI-Li (1st month) than in RI group (3rd month). Euthyroidism slowly decreased in RI-Li group, and not all patients became hypothyroid for 12 months. In contrast, euthyroidism rapidly declined in RI group, and all cured patients became hypothyroid after 6 months.
The short-term treatment with LiCO as an adjunct to I improves efficacy of RIT in patients with long-lasting GH. A success of RIT achieves faster in lithium-treated than in RI group. Treatment with LiCO for 7 days prevents transient worsening of hyperthyroidism after RIT. Short-term use of LiCO shows no toxic side effects.
格雷夫斯甲亢（GH）患者放射性碘治疗（RIT）的效果主要取决于放射性碘（I）摄取及碘在甲状腺内的有效半衰期。研究表明，碳酸锂（LiCO）可延长碘的半衰期，并增加甲状腺所接受的辐射剂量，且不影响甲状腺对碘的摄取。我们研究了LiCO短期治疗对长期GH患者RIT疗效的影响、其对RIT后7天甲状腺激素水平的影响以及可能的副作用。
前瞻性研究纳入30例接受LiCO和I治疗的患者（RI-Li组）以及30例仅接受I治疗的患者（RI组）。LiCO（900mg/天）治疗在RIT前1天开始，并在RIT后持续6天。抗甲状腺药物在RIT前7天停用。患者随访12个月。我们将RIT成功定义为甲状腺功能正常或减退，失败定义为持续性甲亢。
在RI-Li组中，RIT前血清锂水平为0.571±0.156mmol/l。仅在RI组中，RIT后7天血清总甲状腺素（TT）和游离甲状腺素（FT）水平升高，促甲状腺激素（TSH）水平降低。LiCO治疗期间未观察到毒性作用。12个月后，RI组RIT成功率为73.3%，RI-Li组为90.0%（P<0.01）。RI-Li组（第1个月）比RI组（第3个月）更快达到甲状腺功能减退。RI-Li组甲状腺功能正常缓慢下降，并非所有患者在12个月时都变为甲状腺功能减退。相比之下，RI组甲状腺功能正常迅速下降，所有治愈患者在6个月后变为甲状腺功能减退。
LiCO作为I的辅助进行短期治疗可提高长期GH患者RIT的疗效。锂治疗组比RI组更快实现RIT成功。LiCO治疗7天可防止RIT后甲亢的短暂恶化。LiCO短期使用未显示出毒性副作用。
