Determining the best dose of lithium carbonate as adjuvant therapy to radioactive iodine for the treatment of hyperthyroidism: a systematic review and meta-analysis.
Mohamed Abd-ElGawad, Mahmoud Shaaban Abdelgalil, Manar Mabrouk, Sara Adel Abdelkader Saed, Moaz Salama, Ahmed Farid Gadelmawla
{"title":"Determining the best dose of lithium carbonate as adjuvant therapy to radioactive iodine for the treatment of hyperthyroidism: a systematic review and meta-analysis.","authors":"Mohamed Abd-ElGawad, Mahmoud Shaaban Abdelgalil, Manar Mabrouk, Sara Adel Abdelkader Saed, Moaz Salama, Ahmed Farid Gadelmawla","doi":"10.1186/s12902-024-01821-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hyperthyroidism poses challenges, and common treatments like Radioactive Iodine (RAI) have limitations, prompting exploration of adjunctive approaches. This meta-analysis evaluates the combined impact of RAI and Lithium carbonate (LiCO3) on cure rates and thyroid hormone levels.</p><p><strong>Methods: </strong>We systematically searched Cochrane Library, PubMed, Scopus, and Web of Science for studies comparing LiCO3 combined with RAI to RAI alone. Pooled results analyzed cure rates and Free T3/T4 changes. A subgroup analysis was conducted based on LiCO3 dosage and treatment duration, while meta-regression was performed to assess covariates such as the patient's age, RAI dose, and lithium dose. The risk of bias was evaluated using ROB2, ROBINS-1, and NOS, while the statistical analyses were conducted using Revman software 5.4.1.</p><p><strong>Results: </strong>Analysis of 14 studies involving 2047 patients revealed a significantly increased cure rate with RAI and LiCO3 compared to RAI alone (RR 1.12, 95% CI [1.03,1.23], p = 0.01). Subgroup analysis revealed higher cure rates with short-duration intensified doses of LiCO3, while short-duration diluted doses reduced cure rates. No significant differences were noted in euthyroid and hypothyroid states. Changes in free T3 showed no significant difference between the arms at 7 days and the most common time point. A significant decrease in free T4 favored RAI with LiCO3 at 7 days (MD -4.90, 95% CI [-7.91, -1.89], p = 0.001), and the most common time point (MD -3.83, 95% CI [-7.45, -0.20], p = 0.04). Meta-regression analysis indicated better cure rates in older patients (p < 0.001) and lower total lithium doses (p < 0.001).</p><p><strong>Conclusion: </strong>Treatment with RAI combined with LiCO3 significantly enhanced cure rates, particularly when using short-duration intensified doses of LiCO3. Additionally, LiCO3 effectively reduced T4 levels without altering T3 levels. Future research is needed to validate our findings.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9152,"journal":{"name":"BMC Endocrine Disorders","volume":"25 1","pages":"135"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100783/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Endocrine Disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12902-024-01821-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hyperthyroidism poses challenges, and common treatments like Radioactive Iodine (RAI) have limitations, prompting exploration of adjunctive approaches. This meta-analysis evaluates the combined impact of RAI and Lithium carbonate (LiCO3) on cure rates and thyroid hormone levels.
Methods: We systematically searched Cochrane Library, PubMed, Scopus, and Web of Science for studies comparing LiCO3 combined with RAI to RAI alone. Pooled results analyzed cure rates and Free T3/T4 changes. A subgroup analysis was conducted based on LiCO3 dosage and treatment duration, while meta-regression was performed to assess covariates such as the patient's age, RAI dose, and lithium dose. The risk of bias was evaluated using ROB2, ROBINS-1, and NOS, while the statistical analyses were conducted using Revman software 5.4.1.
Results: Analysis of 14 studies involving 2047 patients revealed a significantly increased cure rate with RAI and LiCO3 compared to RAI alone (RR 1.12, 95% CI [1.03,1.23], p = 0.01). Subgroup analysis revealed higher cure rates with short-duration intensified doses of LiCO3, while short-duration diluted doses reduced cure rates. No significant differences were noted in euthyroid and hypothyroid states. Changes in free T3 showed no significant difference between the arms at 7 days and the most common time point. A significant decrease in free T4 favored RAI with LiCO3 at 7 days (MD -4.90, 95% CI [-7.91, -1.89], p = 0.001), and the most common time point (MD -3.83, 95% CI [-7.45, -0.20], p = 0.04). Meta-regression analysis indicated better cure rates in older patients (p < 0.001) and lower total lithium doses (p < 0.001).
Conclusion: Treatment with RAI combined with LiCO3 significantly enhanced cure rates, particularly when using short-duration intensified doses of LiCO3. Additionally, LiCO3 effectively reduced T4 levels without altering T3 levels. Future research is needed to validate our findings.
背景：甲状腺机能亢进带来了挑战，常见的治疗方法如放射性碘（RAI）有局限性，促使人们探索辅助治疗方法。本荟萃分析评估了RAI和碳酸锂（LiCO3）对治愈率和甲状腺激素水平的综合影响。方法：系统检索Cochrane Library、PubMed、Scopus和Web of Science，比较LiCO3联合RAI与单独RAI的比较研究。合并结果分析治愈率和游离T3/T4变化。根据LiCO3剂量和治疗时间进行亚组分析，同时进行meta回归评估患者年龄、RAI剂量和锂剂量等协变量。采用ROB2、ROBINS-1、NOS进行偏倚风险评价，采用Revman软件5.4.1进行统计学分析。结果：对涉及2047例患者的14项研究的分析显示，与单独使用RAI相比，RAI和LiCO3的治愈率显著提高（RR 1.12, 95% CI [1.03,1.23], p = 0.01）。亚组分析显示，短期强化剂量的LiCO3治愈率较高，而短期稀释剂量的治愈率降低。甲状腺功能正常状态和甲状腺功能减退状态无显著差异。游离T3的变化在7天和最常见的时间点在两组之间没有显著差异。游离T4水平的显著降低有利于在第7天（MD -4.90, 95% CI [-7.91, -1.89], p = 0.001）和最常见的时间点（MD -3.83, 95% CI [-7.45, -0.20], p = 0.04）。荟萃回归分析显示，老年患者的治愈率更高(p)。结论：RAI联合LiCO3治疗可显著提高治愈率，特别是在使用短时间强化剂量的LiCO3时。此外，LiCO3在不改变T3水平的情况下有效降低了T4水平。需要进一步的研究来验证我们的发现。临床试验号：不适用。
期刊介绍：
BMC Endocrine Disorders is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of endocrine disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
