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Comparison of Radioiodine with Radioiodine plus Lithium in the Treatment of Graves’ Hyperthyroidism¹

Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro (F.B., L.B., S.B., G.S., A.B., A.C., L.M., A.P., E.M.), University of Pisa, 56122 Pisa, Italy; and Reparto di Epidemiologia e Biostatistica, Istituto di Fisiologia Clinica (G.R.), National Research Council (C.N.R.), 56100 Pisa, Italy.

Address all correspondence and requests for reprints to: Enio Martino, M.D., Dipartimento di Endocrinologia e Metabolismo, Ortopedia e Traumatologia, Medicina del Lavoro, University of Pisa, Ospedale di Cisanello, Via Paradisa, 2, 56122, Pisa, Italy.

Effectiveness of radioiodine for Graves’ hyperthyroidism depends also on its intrathyroidal persistence. The latter is enhanced by lithium by blocking iodine release from the thyroid. One hundred ten patients with Graves’ hyperthyroidism were randomly assigned to treatment with radioiodine or radioiodine plus lithium, stratified according to goiter size (40 or >40 mL) and evaluated for changes in thyroid function and goiter size, at monthly intervals, for 12 months.

Cure of hyperthyroidism occurred in 33 of 46 patients (72%) treated with radioiodine and in 45 of 54 patients (83%) treated with radioiodine plus lithium. The probability of curing hyperthyroidism was higher and its control prompter (P = 0.02) in the radioiodine-plus-lithium group. Patients with 40-mL goiters had similar persistence of hyperthyroidism (13%), but lithium-treated patients had hyperthyroidism controlled earlier (P = 0.04). Among patients with >40-mL goiters, hyperthyroidism was cured in 6 of 15 patients (40%) treated with radioiodine alone and in 12 of 16 patients (75%) treated with radioiodine plus lithium (P = 0.07), and cure occurred earlier in the latter (P = 0.05). Goiters shrank in both groups (P < 0.0001), more effectively and promptly (P < 0.0005) in the radioiodine-plus-lithium group. Serum free T₄ and T₃ levels increased shortly after therapy only in the radioiodine group (P < 0.01).

Lithium carbonate enhances the effectiveness of radioiodine therapy, in terms of prompter control of hyperthyroidism, in patients with small or large goiters. In the latter group, lithium also increases the rate of permanent control of hyperthyroidism.

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