Lithium as an Alternative Option in Graves Thyrotoxicosis
Joint Authors
Prakash, Ishita
Nylen, Eric Sixtus
Sen, Sabyasachi
Source
Issue
Vol. 2015, Issue 2015 (31 Dec. 2015), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2015-09-06
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
A 67-year-old woman was admitted with signs and symptoms of Graves thyrotoxicosis.
Biochemistry results were as follows: TSH was undetectable; FT4 was >6.99 ng/dL (0.7–1.8); FT3 was 18 pg/mL (3–5); TSI was 658% (0–139).
Thyroid uptake and scan showed diffusely increased tracer uptake in the thyroid gland.
The patient was started on methimazole 40 mg BID, but her LFTs elevated precipitously with features of fulminant hepatitis.
Methimazole was determined to be the cause and was stopped.
After weighing pros and cons, lithium was initiated to treat her persistent thyrotoxicosis.
Lithium 300 mg was given daily with a goal to maintain between 0.4 and 0.6.
High dose Hydrocortisone and propranolol were also administered concomitantly.
Free thyroid hormone levels decreased and the patient reached a biochemical and clinical euthyroid state in about 8 days.
Though definitive RAI was planned, the patient has been maintained on lithium for more than a month to control her hyperthyroidism.
Trial removal of lithium results in reemergence of thyrotoxicosis within 24 hours.
Patient was maintained on low dose lithium treatment with lithium level just below therapeutic range which was sufficient to maintain euthyroid state for more than a month.
There were no signs of lithium toxicity within this time period.
Conclusion.
Lithium has a unique physiologic profile and can be used to treat thyrotoxicosis when thionamides cannot be used while awaiting elective radioablation.
Lithium levels need to be monitored; however, levels even at subtherapeutic range may be sufficient to treat thyrotoxicosis.
American Psychological Association (APA)
Prakash, Ishita& Nylen, Eric Sixtus& Sen, Sabyasachi. 2015. Lithium as an Alternative Option in Graves Thyrotoxicosis. Case Reports in Endocrinology،Vol. 2015, no. 2015, pp.1-4.
https://search.emarefa.net/detail/BIM-1058427
Modern Language Association (MLA)
Prakash, Ishita…[et al.]. Lithium as an Alternative Option in Graves Thyrotoxicosis. Case Reports in Endocrinology No. 2015 (2015), pp.1-4.
https://search.emarefa.net/detail/BIM-1058427
American Medical Association (AMA)
Prakash, Ishita& Nylen, Eric Sixtus& Sen, Sabyasachi. Lithium as an Alternative Option in Graves Thyrotoxicosis. Case Reports in Endocrinology. 2015. Vol. 2015, no. 2015, pp.1-4.
https://search.emarefa.net/detail/BIM-1058427
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1058427