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Lithium as a Potential Adjuvant to ¹³¹I Therapy of Metastatic, Well Differentiated Thyroid Carcinoma¹

Nuclear Medicine Department, Warren Grant Magnuson Clinical Center (S.-S.K., J.C.R., A.M.K.), and the Clinical Endocrinology (E.G.M., K.B.A., M.C.L., J.R.) and Genetics and Biochemistry Branchs, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: James C. Reynolds, M.D., Building 10, Room 1C-401, National Institutes of Health, Bethesda, Maryland 20892.

As lithium inhibits the release of iodine from the thyroid but does not change iodine uptake, it may potentiate ¹³¹I therapy of thyroid cancer. The effects of lithium on the accumulation and retention of ¹³¹I in metastatic lesions and thyroid remnants were evaluated in 15 patients with differentiated thyroid carcinoma. Two ¹³¹I turnover studies were performed while the patients were hypothyroid. One was performed while the patient received lithium; the second served as a control study. From a series of -camera images, it was found that lithium increased ¹³¹I retention in 24 of 31 metastatic lesions and in 6 of 7 thyroid remnants. A comparison of ¹³¹I retention during lithium with that during the control period showed that the mean increase in the biological or retention half-life was 50% in tumors and 90% in remnants. This increase occurred in at least 1 lesion in each patient and was proportionally greater in lesions with poor ¹³¹I retention. When the control biological half life was less than 3 days, lithium prolonged the effective half-life, which combines both biological turnover and isotope decay, in responding metastases by more than 50%. More ¹³¹I also accumulated during lithium therapy, probably as a consequence of its effect on iodine release. The increase in the accumulated ¹³¹I and the lengthening of the effective half-life combined to increase the estimated ¹³¹I radiation dose in metastatic tumor by 2.29 ± 0.58 (mean ± SEM) times. These studies suggest that lithium may be a useful adjuvant for ¹³¹I therapy of thyroid cancer, augmenting both the accumulation and retention of ¹³¹I in lesions.

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