Short term treatment with lithium carbonate as adjunct to radioiodine treatment for long-lasting Graves' hyperthyroidism

Objective: Lithium carbonate is primarily used for the treatment of patients with bipolar affective disorders. Initial treatment of Graves' hyperthyroidism (GHT) with antithyroid drugs (ATD) has limitations at over 50% of treated patients because of significant side effects and relatively high relapses of the disease after drugs withdrawal.Till now, the influence of LiCO3 on RIT outcome was mainly studied in patients with recent onset of GHT, and results were contradicted. Meta-analysis of case-control studies showed higher rated hypothyroidism in patients with mood disorders treated with LiCO3 (121/869) than in controls (10/578).Although in a small number of patients (n=28) with long-lasting GHT, preliminary results of ours showed that I-131 treatment with LiCO3 for 7 days significantly improved the efficacy of RIT versus the non-LiCO3 treated patients (P<0.001). Lithium treated patients were cured faster (12 of 13 patients were cured after one month) than those treated only with I-131(8 patients were cured after one and 11/15 patients after 12 months). Fewer patients treated with I-131 and LiCO3 had persistent hyperthyroidism than those treated with I-131 alone. There were no toxic effects of LiCO3 during 7 days treatment. Conclusion: These observations indicate of that short-term treatment with LiCO3 in GHT patients as adjunct I-131-Nal improves the efficacy of RIT, prevents transient exacerbation of hyperthyroidism, early induction of hypothyroidism and does not worsen ophthalmopathy.