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.

Keywords: Adjuvant therapy; Hyperthyroidism; Lithium carbonate; Meta-analysis; Radioactive iodine.

© 2024. The Author(s).

背景：

甲状腺功能亢进症的治疗面临挑战，常用的治疗方法如放射性碘（RAI）存在局限性，这促使人们探索辅助疗法。本元分析评估了放射性碘与碳酸锂联合使用对治愈率和甲状腺激素水平的影响。

方法：

我们系统地搜索了Cochrane Library、PubMed、Scopus和Web of Science数据库，寻找将碳酸锂与RAI联合应用与单独使用RAI进行比较的研究。汇总结果分析了治愈率和游离T3/T4的变化情况。基于碳酸锂剂量和治疗持续时间进行了亚组分析，并通过元回归评估协变量如患者的年龄、放射性碘的剂量以及碳酸锂的剂量的影响。采用ROB2、ROBINS-1 和 NOS 评价偏倚风险，统计分析则使用Revman软件5.4.1进行。

结果：

对涉及2047名患者的14项研究进行了分析，结果显示与单独使用RAI相比，联合使用RAI和碳酸锂的治愈率显著提高（RR 1.12, 95% CI [1.03,1.23], p = 0.01）。亚组分析显示短期高剂量治疗组中碳酸锂的治愈率更高，而短期低剂量则降低了治愈率。在正常甲状腺功能和甲状腺机能减退状态之间没有发现显著差异。游离T3水平的变化在7天及最常见的观察时间点上未见显著不同。然而，在7天（MD -4.90, 95% CI [-7.91, -1.89], p = 0.001）和最常见的时间点（MD -3.83, 95% CI [-7.45, -0.20], p = 0.04），使用碳酸锂与RAI联合治疗导致游离T4水平显著降低。元回归分析表明，年龄较大患者(p

结论：

使用放射性碘与碳酸锂联合治疗可显著提高治愈率，特别是当采用短期高剂量碳酸锂时。此外，碳酸锂在不改变T3水平的情况下有效降低了T4水平。未来的研究需要验证我们的发现。

临床试验编号：

不适用。

关键词：

辅助治疗；甲状腺功能亢进症；碳酸锂；元分析；放射性碘。

© 2024. 作者保留所有权利。