Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy
BackgroundLithium 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...
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Frontiers Media S.A.
2024-04-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2024.1382024/full |
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| author | Fadi Khreish Fadi Khreish Andrea Schaefer-Schuler Leonie Roth Caroline Burgard Florian Rosar Samer Ezziddin |
| author_facet | Fadi Khreish Fadi Khreish Andrea Schaefer-Schuler Leonie Roth Caroline Burgard Florian Rosar Samer Ezziddin |
| author_sort | Fadi Khreish |
| collection | DOAJ |
| description | BackgroundLithium 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.MethodsWe 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 post-RAI, 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.ResultsThe 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.ConclusionLithium 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. |
| first_indexed | 2024-04-24T13:11:59Z |
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| language | English |
| last_indexed | 2024-04-24T13:11:59Z |
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| spelling | doaj.art-a3fddcb63ffb4e7db27a72e28f532edc2024-04-05T04:26:39ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2024-04-011110.3389/fmed.2024.13820241382024Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapyFadi Khreish0Fadi Khreish1Andrea Schaefer-Schuler2Leonie Roth3Caroline Burgard4Florian Rosar5Samer Ezziddin6Department of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyDepartment of Nuclear Medicine, Campus-Fulda, University of Marburg, Fulda, GermanyDepartment of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyDepartment of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyDepartment of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyDepartment of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyDepartment of Nuclear Medicine, Saarland University Hospital, Homburg, GermanyBackgroundLithium 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.MethodsWe 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 post-RAI, 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.ResultsThe 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.ConclusionLithium 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.https://www.frontiersin.org/articles/10.3389/fmed.2024.1382024/fullGraves’ diseaseradioiodine therapylithiumdosimetryadministered activitythyroidal radioiodine uptake |
| spellingShingle | Fadi Khreish Fadi Khreish Andrea Schaefer-Schuler Leonie Roth Caroline Burgard Florian Rosar Samer Ezziddin Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy Frontiers in Medicine Graves’ disease radioiodine therapy lithium dosimetry administered activity thyroidal radioiodine uptake |
| title | Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy |
| title_full | Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy |
| title_fullStr | Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy |
| title_full_unstemmed | Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy |
| title_short | Concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves’ disease: comparison of conventional versus lithium-augmented radioiodine therapy |
| title_sort | concomitant lithium increases radioiodine uptake and absorbed doses per administered activity in graves disease comparison of conventional versus lithium augmented radioiodine therapy |
| topic | Graves’ disease radioiodine therapy lithium dosimetry administered activity thyroidal radioiodine uptake |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2024.1382024/full |
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