title: Adjuvant lithium improves the efficacy of radioactive iodine treatment in Graves' and toxic nodular disease.
abstract: BACKGROUND
  Lithium increases iodine retention in the thyroid gland and inhibits thyroid hormone release. Although lithium has been reported to improve the efficacy of radioactive iodine (RAI) treatment in Graves' disease, its role as an adjunct to RAI treatment of hyperthyroidism, particularly in toxic nodular disease, remains contentious.
  
  
  OBJECTIVE
  To assess whether adjuvant lithium increases the efficacy of a fixed dose RAI regimen in Graves' and toxic nodular hyperthyroid patients.
  
  
  METHODS
  Retrospective cohort study in a tertiary referral centre. Two hundred and four hyperthyroid patients (163 Graves' disease, 26 toxic multinodular goitre and 15 solitary toxic thyroid adenoma).
  
  
  METHODS
  One hundred and three patients received RAI alone (median dose 558 MBq). One hundred and one patients received RAI (median dose 571 MBq) with adjuvant lithium (800 mg/day for 10 days).
  
  
  METHODS
  Proportion of patients cured at any time over a 1-year period following RAI treatment. Cure was defined as sustained (two or more sequential time points) biochemical euthyroidism or hypothyroidism during the follow-up period.
  
  
  RESULTS
  The likelihood of cure at any time was 60% greater in all hyperthyroid patients (Graves' plus toxic nodular disease) receiving adjuvant lithium (n = 204, P = 0·003). In patients with Graves' disease receiving RAI + lithium, there was a similar occurrence in cure (n = 163, P = 0·006). Cure was twice as likely in patients with toxic nodular (non-Graves') disease receiving RAI + lithium compared with RAI alone (n = 41, P = 0·01).
  
  
  CONCLUSIONS
  This study supports the use of adjuvant lithium to improve the efficacy of RAI in the treatment of Grave's disease and suggests a novel role in the management of toxic nodular (non-Graves') disease.
authors.affiliation: Imperial Centre for Endocrinology, Imperial College Healthcare NHS Trust, UK. n.martin@imperial.ac.uk
authors.forename: Niamh M
authors.initials: NM
authors.lastname: Martin
authors.forename: Miraj
authors.initials: M
authors.lastname: Patel
authors.forename: Gurjinder M K
authors.initials: GM
authors.lastname: Nijher
authors.forename: Shivani
authors.initials: S
authors.lastname: Misra
authors.forename: Elaine
authors.initials: E
authors.lastname: Murphy
authors.forename: Karim
authors.initials: K
authors.lastname: Meeran
mesh_terms: D000328:Adult; D005260:Female; D006111:Graves Disease / Q000532:radiotherapy*; D006801:Humans; D006980:Hyperthyroidism / Q000532:radiotherapy; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008094:Lithium / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007457:Iodine Radioisotopes; D008094:Lithium