Determining the best dose of lithium carbonate as adjuvant therapy to radioactive iodine for the treatment of hyperthyroidism: a systematic review and meta-analysis

Abd-ElGawad et al., 2025 | BMC Endocr Disord | Meta Analysis

Citation

Abd-ElGawad Mohamed, Abdelgalil Mahmoud Shaaban, ... Gadelmawla Ahmed Farid. Determining the best dose of lithium carbonate as adjuvant therapy to radioactive iodine for the treatment of hyperthyroidism: a systematic review and meta-analysis. BMC Endocr Disord. 2025-May-23;25(1):135. doi:10.1186/s12902-024-01821-z

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. CLINICAL TRIAL NUMBER: Not applicable.

Key Findings

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

Outcomes Measured

• Requires manual extraction

Population

MeSH Terms

• Humans
• Lithium Carbonate
• Iodine Radioisotopes
• Hyperthyroidism

Evidence Classification

• Level: Meta Analysis
• Publication Types: Journal Article, Systematic Review, Meta-Analysis
• Vertical: iodine

Provenance

• PMID: 40410789
• DOI: 10.1186/s12902-024-01821-z
• PMCID: PMC12100783
• Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09