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Objective <p>Graves’ disease (GD) patients with an advanced radioiodine uptake (RAIU) peak (4&#xa0;h/24&#xa0;h ratio &gt; 1.0) exhibit rapid iodine turnover, which compromises radiation dose delivery and increases <sup>131</sup>I therapy failure. This study aimed to evaluate whether short-term lithium carbonate pretreatment could correct this aberrant kinetic profile and improve the biochemical milieu in this high-risk subgroup.</p> Design &amp; Methods <p>This single-center retrospective cohort included 162 GD patients with an advanced peak, allocated to lithium carbonate (250&#xa0;mg tid for 7&#xa0;days before and 2&#xa0;days after the RAIU test, n = 81) or a control group receiving standard care (n = 81). Primary outcomes were post-intervention 24-h RAIU and 4&#xa0;h/24&#xa0;h RAIU ratio; secondary outcomes included changes in serum free T3 (FT3) and free T4 (FT4) levels.</p> Results <p>Compared to controls, the lithium group achieved a significantly higher 24-h RAIU (85.5% ± 11.5% vs. 65.7% ± 22.1%,&#xa0;<i>P</i> &lt; 0.001). Crucially, the 4&#xa0;h/24&#xa0;h ratio was normalized to 0.92 ± 0.20 in the lithium group versus 1.27 ± 0.40 in controls (<i>P</i> &lt; 0.001). Lithium pretreatment also significantly reduced FT3 (− 7.4 ± 10.1 vs. + 3.2 ± 14.7&#xa0;pmol/L) and FT4 levels (− 16.2 ± 15.3 vs. + 4.1 ± 18.5&#xa0;pmol/L) (both&#xa0;<i>P</i> &lt; 0.001). Adverse events were mild (6.2%, 5 patients), transient, and did not affect treatment.</p> Conclusions <p>Short-term lithium carbonate pretreatment effectively reverses rapid iodine turnover, enhances radioiodine retention, and attenuates rebound hyperthyroidism in GD patients with an advanced RAIU peak. This practical adjunctive strategy therefore holds promise for improving the efficacy of subsequent radioiodine therapy and warrants prospective validation.</p>

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Lithium carbonate pretreatment normalizes rapid iodine turnover in Graves’ disease patients with an advanced radioiodine peak: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年2月23日

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  • Xuemei Gao,
  • Wei Chang,
  • Ke Sun,
  • Baoping Liu,
  • Qiao Ruan,
  • Xingmin Han,
  • Ruihua Wang

摘要

Objective

Graves’ disease (GD) patients with an advanced radioiodine uptake (RAIU) peak (4 h/24 h ratio > 1.0) exhibit rapid iodine turnover, which compromises radiation dose delivery and increases 131I therapy failure. This study aimed to evaluate whether short-term lithium carbonate pretreatment could correct this aberrant kinetic profile and improve the biochemical milieu in this high-risk subgroup.

Design & Methods

This single-center retrospective cohort included 162 GD patients with an advanced peak, allocated to lithium carbonate (250 mg tid for 7 days before and 2 days after the RAIU test, n = 81) or a control group receiving standard care (n = 81). Primary outcomes were post-intervention 24-h RAIU and 4 h/24 h RAIU ratio; secondary outcomes included changes in serum free T3 (FT3) and free T4 (FT4) levels.

Results

Compared to controls, the lithium group achieved a significantly higher 24-h RAIU (85.5% ± 11.5% vs. 65.7% ± 22.1%, P < 0.001). Crucially, the 4 h/24 h ratio was normalized to 0.92 ± 0.20 in the lithium group versus 1.27 ± 0.40 in controls (P < 0.001). Lithium pretreatment also significantly reduced FT3 (− 7.4 ± 10.1 vs. + 3.2 ± 14.7 pmol/L) and FT4 levels (− 16.2 ± 15.3 vs. + 4.1 ± 18.5 pmol/L) (both P < 0.001). Adverse events were mild (6.2%, 5 patients), transient, and did not affect treatment.

Conclusions

Short-term lithium carbonate pretreatment effectively reverses rapid iodine turnover, enhances radioiodine retention, and attenuates rebound hyperthyroidism in GD patients with an advanced RAIU peak. This practical adjunctive strategy therefore holds promise for improving the efficacy of subsequent radioiodine therapy and warrants prospective validation.