National Institute for Health Research Bristol Biomedical Research Centre, (Nutrition Theme), University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK.
NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Clin Endocrinol (Oxf). 2022 Dec;97(6):702-729. doi: 10.1111/cen.14751. Epub 2022 May 24.
Debate remains regarding whether to recommend a low iodine diet (LID) before radioactive-iodine treatment and its duration and stringency. This mixed-methods review aimed to determine if iodine status affects treatment success, the most effective diet to reduce iodine status, and how LID impacts wellbeing.
Five electronic databases were searched until February 2021. An effectiveness synthesis (quantitative studies) and views synthesis (qualitative, survey, and experience-based evidence) were conducted individually and then integrated. Quality assessment was undertaken.
Fifty-six quantitative and three qualitative studies were identified. There was greater ablation success for those with an iodine status of <50 mcg/L (or mcg/gCr) compared with ≥250 (odds ratio [OR] = 2.63, 95% confidence interval [CI], 1.18-5.86, n = 283, GRADE certainty of evidence very low). One study compared <50 mcg/L (or mcg/gCr) to 100-199 and showed similar rates of ablation success (OR = 1.59, 95% CI, 0.48-6.15, n = 113; moderate risk of bias). People following a stricter LID before ablation had similar rates of success to a less-strict diet (OR = 0.67, 95% CI, 0.26-1.73, n = 256, GRADE certainty of evidence very low). A stricter LID reduced iodine status more than a less strict (SMD = -0.40, 95% CI, -0.56 to -0.24, n = 816), and reduction was seen after 1 and 2 weeks. The main challenges were a negative impact on psychological health, over restriction, confusion, and difficulty for sub-groups.
Although a LID of 1-2 weeks reduces iodine status, it remains unclear whether iodine status affects treatment success as only a few low-quality studies have examined this. LIDs are challenging for patients. Higher-quality studies are needed to confirm whether a LID is necessary.
放射性碘治疗前是否推荐低碘饮食（LID）以及持续时间和严格程度仍存在争议。本混合方法综述旨在确定碘状态是否会影响治疗效果、降低碘状态最有效的饮食方法，以及 LID 如何影响健康。
直到 2021 年 2 月，对五个电子数据库进行了搜索。分别进行了有效性综合（定量研究）和观点综合（定性、调查和基于经验的证据），然后进行了整合。进行了质量评估。
确定了 56 项定量研究和 3 项定性研究。与碘状态≥250μg/L（或μg/gCr）相比，碘状态＜50μg/L（或μg/gCr）的患者消融成功率更高（比值比[OR]＝2.63，95%置信区间[CI]：1.18-5.86，n＝283，证据质量等级极低）。一项研究比较了＜50μg/L（或μg/gCr）与 100-199μg/L（或μg/gCr），显示出相似的消融成功率（OR＝1.59，95%CI：0.48-6.15，n＝113；偏倚风险中等）。在消融前遵循更严格 LID 的患者与遵循不太严格饮食的患者成功率相似（OR＝0.67，95%CI：0.26-1.73，n＝256，证据质量等级极低）。严格的 LID 比宽松的 LID 降低碘状态的幅度更大（SMD＝-0.40，95%CI：-0.56 至-0.24，n＝816），并且在 1 周和 2 周后就可观察到降低。主要挑战是对心理健康产生负面影响、过度限制、困惑以及对亚组的困难。
尽管 1-2 周的 LID 可降低碘状态，但只有少数低质量研究检查了这一点，因此仍不清楚碘状态是否会影响治疗效果。LID 对患者来说具有挑战性。需要进行更高质量的研究来确认 LID 是否有必要。
