| Rapid thyroidal iodine turnover contributes to 131I therapy failure inpatients with Graves' Disease(GD). Lithium can significantly affect the kineticsof iodine by blocking its release from thyroid and increasing its retention.Aim: The aim of this study is to investigate the possibility of improving thecost-effectiveness and the results of131I therapy for GD with Lithium.Materials and Methods: 63 patients with GD were studied . All patients haveclinical and biochemical hyperthyroidism . The standard radioactive iodineuptake(RAIU) was performed before 131I therapy or before giving Lithiumcarbonate. A rapid 131I turnover(the ratio between the early and late RAIU is ≥1 ) was showed on all patients who were divided into two groups. Only 131Itherapy was used in G1(control group) including 34 patients, 24 female and 10male, mean age 41.03 ± 13.739 years. 131I plus Lithium therapy inG2(experimental group) including 29 patients, 20 female and 9 male, mean age35.17±11.430 years. After the first RAIU was performed the patients in G2were given 750mg/day Lithium carbonate orally for 3 days. Then a secondRAIU was performed. Thyroid weights were estimated by palpation and thyroidscintigraphy. Mean thyroid weight was 77.26±33.444g at G1 and 87.66±49.618g at G2. A single 131 I dose was used on all patients. Therapy dose was calculatedbased on the 24-hrs uptake from the second RAIU for the patients in G2. Themain factors for the dose selection of each gram of thyroid were the estimatedweight of the thyroid, the peak time and rate of uptake, patient's symptoms,therapeutic history and course of disease and so on. The mean dose was 12.62±7.459 mCi at G1 and 13.37±9.606.mCi at G2 and the mean dose of each gramof thyroid was 101.79±30.396uCi and 107.46±32.881uCi (G1 and G2). Eachpatient in G1 was followed for 12 months, the patients in G2 were followed for11.34±1.11 months.Results: After Lithium was used a rapid 131I turnover was decreased. The ratioof the early and late RAIU was reversed from the ratio ≥ 1 into < 1 in the IVpatients of 86%(25/29 reversion rate) at the experimental group(G2). Of 29evaluated patients at G2, 27(27/29,93.10%) had a successful outcome after asingle dose of 131I. while the successful rate(%) was 70.59%(24/34) at thecontrol group (G1),p<0.05. The comparison of therapeutic results in patients atgroups(G1 & 2) treated with131I was listed in the table below. Group Patient No. Successful No(%) Unsuccessful No(%) G1 34 24(70.59) 10(29.41) G2 29 27(93.10) 2(6.90)Conclusion: 1. Lithium carbonate may reverse the 131I uptake ratio of the earlyand late RAIU in the patients of 86%. 2. Because of the rapid 131I turnover wasreverse the therapeutic results could be improved. 3. Lithium plus 131I may be acost-effective therapy method, But more cases is needed for the further study. |
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