Lithium as an Alternative Option in Graves Thyrotoxicosis
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 thyro...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2015/869343 |
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| author | Ishita Prakash Eric Sixtus Nylen Sabyasachi Sen |
| author_facet | Ishita Prakash Eric Sixtus Nylen Sabyasachi Sen |
| author_sort | Ishita Prakash |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-200d7a5b1328486a8482df0f0f0c61dc |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-200d7a5b1328486a8482df0f0f0c61dc2025-02-03T01:03:26ZengWileyCase Reports in Endocrinology2090-65012090-651X2015-01-01201510.1155/2015/869343869343Lithium as an Alternative Option in Graves ThyrotoxicosisIshita Prakash0Eric Sixtus Nylen1Sabyasachi Sen2Department of Medicine, Division of Endocrinology & Metabolism, Medical Faculty Associates, The George Washington University, Washington, DC, USADepartment of Medicine, Division of Endocrinology & Metabolism, Medical Faculty Associates, The George Washington University, Washington, DC, USADepartment of Medicine, Division of Endocrinology & Metabolism, Medical Faculty Associates, The George Washington University, Washington, DC, USAA 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.http://dx.doi.org/10.1155/2015/869343 |
| spellingShingle | Ishita Prakash Eric Sixtus Nylen Sabyasachi Sen Lithium as an Alternative Option in Graves Thyrotoxicosis Case Reports in Endocrinology |
| title | Lithium as an Alternative Option in Graves Thyrotoxicosis |
| title_full | Lithium as an Alternative Option in Graves Thyrotoxicosis |
| title_fullStr | Lithium as an Alternative Option in Graves Thyrotoxicosis |
| title_full_unstemmed | Lithium as an Alternative Option in Graves Thyrotoxicosis |
| title_short | Lithium as an Alternative Option in Graves Thyrotoxicosis |
| title_sort | lithium as an alternative option in graves thyrotoxicosis |
| url | http://dx.doi.org/10.1155/2015/869343 |
| work_keys_str_mv | AT ishitaprakash lithiumasanalternativeoptioningravesthyrotoxicosis AT ericsixtusnylen lithiumasanalternativeoptioningravesthyrotoxicosis AT sabyasachisen lithiumasanalternativeoptioningravesthyrotoxicosis |