Please use this identifier to cite or link to this item: doi:10.22028/D291-42181
Title: Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves' disease: comparison of conventional versus lithium-augmented radioiodine therapy
Author(s): Khreish, Fadi
Schaefer-Schuler, Andrea
Roth, Leonie
Burgard, Caroline
Rosar, Florian
Ezziddin, Samer
Language: English
Title: Frontiers in Medicine
Volume: 11
Publisher/Platform: Frontiers
Year of Publication: 2024
Free key words: Graves’ disease
radioiodine therapy
administered activity
thyroidal radioiodine uptake
thyroid dose
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Background: Lithium inhibits iodine and thyroid hormone release from thyroid cells, possibly increasing radioiodine retention and anti-hyperthyroid efficacy when given adjunctively to radioiodine therapy (RAI) of Graves’ disease (GD). However, the literature contains limited dosimetric data regarding the influence of concomitant lithium in this setting. Methods: We retrospectively compared dosimetric variables in patients undergoing RAI with/without adjunctive lithium (n  =  52 each). We assessed two low-dose, short-duration oral lithium carbonate regimens, 450  mg/d (n  =  22) or 900  mg/d (n  =  30), for a mean of 4.7  ±  1.4 d starting upon RAI administration. Patients underwent diagnostic testing to measure thyroidal radioiodine uptake (RAIU) 24  h  ±  2  h after ingesting up to 5  MBq radioiodine, receiving individualized RAI activities 24  h later. Using ≥3 RAIU daily measurements starting 24  h postRAI, researchers were able to determine the effective radioiodine half-life and absorbed dose to the thyroid; we also calculated the absorbed dose per administered activity concentration within that organ. Rates of GD cure, defined as reaching euthyroidism or hypothyroidism post-RAI, were evaluated in patients with ~6  months or longer post-RAI follow-up. Results: The lithium dosage subgroups had similar dosimetric values and thus are considered together. Lithium patients and controls had similar average “diagnostic” RAIU (51.1%  ±  15.7% vs. 50.6%  ±  13.8%, p  =  0.820), but the former had significantly higher RAIU post-RAI (56.3%  ±  13.5% vs. 49.1%  ±  13.5%, p  =  0.002), reflecting significantly greater change in the former (+16.2%  ±  30.4% vs. -1.8%  ±  16.1%, p  =  0.001). Radioiodine effective half-life was non-significantly longer in lithium patients (5.43  ±  1.50 d vs. 5.08  ±  1.16 d, p  =  0.192). The mean RAI administered activity was 27% less in lithium patients (677  ±  294  MBq vs. 930  ±  433  MBq, p  =  0.001), but GD cure rates were similar (83% [39/47] vs. 82% [33/40], p  =  0.954), possibly due to the significantly higher thyroid dose in the lithium patients, especially in thyroid gland with a volume ≤  20  mL (1.04  ±  0.44  Gy/ MBq vs. 0.76  ±  0.30  Gy/MBq, p  =  0.020). Day 3 serum lithium concentrations were low (450  mg/d: 0.26  ±  0.12  mmol/L, 900  mg/d: 0.50  ±  0.18  mmol/L); no lithium toxicity was noted.Conclusion: Lithium augmentation may increase the RAIU and thyroid absorbed dose, permitting potentially decreased RAI activities without sacrificing efficacy. Our observations should be confirmed in a prospective, randomized trial.
DOI of the first publication: 10.3389/fmed.2024.1382024
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-421816
ISSN: 2296-858X
Date of registration: 13-Jun-2024
Faculty: M - Medizinische Fakultät
Department: M - Radiologie
Professorship: M - Prof. Dr. Samer Ezziddin
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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