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Meta-Analysis
. 2021 Apr 12;21(1):64.
doi: 10.1186/s12902-021-00729-2.

Lithium carbonate as add-on therapy to radioiodine in the treatment on hyperthyroidism: a systematic review and meta-analysis

Mohamed Abd-ElGawad  1 , Mohamed Abdelmonem  2 , Ahmed Eissa Ahmed  2 , Omar Magdy Mohammed  2 , Mohamed Sayed Zaazouee  3 , Ahmed Assar  4 , Mohamed Gadelkarim  5 , Ahmed M Afifi  6
Affiliations
Meta-Analysis

Lithium carbonate as add-on therapy to radioiodine in the treatment on hyperthyroidism: a systematic review and meta-analysis

Mohamed Abd-ElGawad et al. BMC Endocr Disord. .

Abstract

Background: The main purpose is to investigate the effect of LiCO3 as an add-on therapy with radioactive iodine in increasing the cure and decreasing the T4 level compared to radioactive iodine alone. The primary outcome is the cure rate as defined by the number of hyperthyroid patients who became euthyroid or hypothyroid. The secondary outcome is the T4 level.

Methods: Four databases were searched (PubMed, Scopus, Web of Science, and Cochrane central library). The inclusion criteria were randomized and non-randomized clinical trials of hyperthyroidism patients receiving LiCO3 with radioiodine compared with hyperthyroidism patients receiving radioactive iodine alone. Included studies were appraised with the risk of bias version 2 tool, according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.

Results: Nine studies were eligible for inclusion in the study, six randomized control trials and three non-randomized control trials. There were 477 patients in the intervention group and 451 patients in the control group. The cure rate was not significantly different between the two groups, while it was significantly increased with 5000 to 6500 mg optimized cumulative dose of LiCO3 compared with the control group, P = 0.0001. The T4 level showed no significant difference between the two groups, P = 0.13.

Conclusions: LiCO3 adjunct to radioactive iodine did not show significant differences compared with radioactive iodine alone in terms of cure rate or decreasing T4 level. However, the dose of 5000 to 6000 mg of LiCO3 may increase the cure rate.

Keywords: Cure rate; Hyperthyroidism; Lithium carbonate; Radioactive iodine.

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Conflict of interest statement

Dr. Abd-ElGawad has nothing to disclose. All the authors also declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the study selection process
Fig. 2
Fig. 2
Risk of bias graph for randomized controlled trials using ROB2
Fig. 3
Fig. 3
Risk of bias summary for randomized controlled trials using ROB2
Fig. 4
Fig. 4
Funnel plot showing the risk of bias across the included studies
Fig. 5
Fig. 5
The cure rate defined as euthyroidism or hypothyroidism, sub grouped according study design whether randomized or not. LiCO3: lithium carbonate, I131: radioiodine 131
Fig. 6
Fig. 6
The cure rate defined as euthyroidism or hypothyroidism for a certain selected medium dose (5000–6500 mg) of lithium carbonate. LiCO3: lithium carbonate, I131: radioiodine 131
Fig. 7
Fig. 7
Serum total thyroxine (T4) as a secondary outcome. LiCO3: lithium carbonate, I131: radioiodin
See this image and copyright information in PMC

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