Frontiers in endocrinology · 2026
Lithium carbonate bridging and outcomes of radioiodine therapy in severe Graves' disease: a retrospective cohort study.
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Gao Xuemei, Chang Wei, Sun Ke, Liu Baoping, Ruan Qiao, Han Xingmin, Wang Ruihua
Аннотация
OBJECTIVE: This study evaluated whether a short-term lithium carbonate bridging therapy was associated with improved outcomes of subsequent radioiodine (RAI) therapy in patients with severe Graves' disease during the high-risk interval after antithyroid drug (ATD) cessation.
METHODS: In this single-center retrospective cohort, adults with severe Graves' disease undergoing RAI were included. The lithium group (n=46) received lithium (serum target 0.6-1.0 mmol/L) from ATD withdrawal until 7 days post-RAI, while the standard-care group (n=100) received routine management without lithium bridging. The primary outcome was thyroid function status at 6 months, defined biochemically: euthyroidism (normal TSH, FT3, FT4 within reference ranges), hypothyroidism (elevated TSH with low FT4), or treatment failure (persistent hyperthyroidism or need for repeat RAI/surgery within 6 months).
RESULTS: Lithium bridging was associated with a higher euthyroidism rate (30.4% vs. 13.0%, P = 0.009) and a lower hypothyroidism rate (54.3% vs. 77.0%, P = 0.005) compared to standard care. This was preceded by a significant reduction in serum FT3 and FT4 following lithium initiation (P < 0.001). Treatment was well tolerated, with mild gastrointestinal side effects in 8.7% and no cases of thyroid storm (0% vs. 3.0% in standard-care group). Multivariate analysis confirmed pre-RAI FT3 as a key modifiable risk factor for treatment failure (adjusted OR 1.55 per 5 pmol/L increase, 95% CI 1.15-2.09, P = 0.004). Within the lithium group, the magnitude of FT3 reduction (ΔFT3) was independently associated with treatment success (adjusted OR 0.45 per 5 pmol/L decrease, 95% CI 0.22-0.92, P = 0.028).
CONCLUSION: Pre-RAI lithium carbonate bridging may be associated with improved therapeutic outcomes in severe Graves' disease, potentially mediated through reduction in serum FT3. These findings support the need for prospective randomized studies to confirm the role of lithium as a bridging strategy in high-risk patients.
METHODS: In this single-center retrospective cohort, adults with severe Graves' disease undergoing RAI were included. The lithium group (n=46) received lithium (serum target 0.6-1.0 mmol/L) from ATD withdrawal until 7 days post-RAI, while the standard-care group (n=100) received routine management without lithium bridging. The primary outcome was thyroid function status at 6 months, defined biochemically: euthyroidism (normal TSH, FT3, FT4 within reference ranges), hypothyroidism (elevated TSH with low FT4), or treatment failure (persistent hyperthyroidism or need for repeat RAI/surgery within 6 months).
RESULTS: Lithium bridging was associated with a higher euthyroidism rate (30.4% vs. 13.0%, P = 0.009) and a lower hypothyroidism rate (54.3% vs. 77.0%, P = 0.005) compared to standard care. This was preceded by a significant reduction in serum FT3 and FT4 following lithium initiation (P < 0.001). Treatment was well tolerated, with mild gastrointestinal side effects in 8.7% and no cases of thyroid storm (0% vs. 3.0% in standard-care group). Multivariate analysis confirmed pre-RAI FT3 as a key modifiable risk factor for treatment failure (adjusted OR 1.55 per 5 pmol/L increase, 95% CI 1.15-2.09, P = 0.004). Within the lithium group, the magnitude of FT3 reduction (ΔFT3) was independently associated with treatment success (adjusted OR 0.45 per 5 pmol/L decrease, 95% CI 0.22-0.92, P = 0.028).
CONCLUSION: Pre-RAI lithium carbonate bridging may be associated with improved therapeutic outcomes in severe Graves' disease, potentially mediated through reduction in serum FT3. These findings support the need for prospective randomized studies to confirm the role of lithium as a bridging strategy in high-risk patients.