Lithium Carbonate in the Treatment of Graves’ Disease with ATD-Induced Hepatic Injury or Leukopenia

Ruan, Zheng; Liu, Kemian; Chen, Kun; Cao, Wenwu; Cao, Lin; Zhang, Huifeng; Sun, Hongping; Liu, Chao

doi:10.1155/2015/694023

Cited by 11 publications

(11 citation statements)

References 34 publications

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“…21 The failure of LC treatment may be related to high levels of THs, the presence of TRAB, and thyroiditis. 20 Although these factors were present in our case, the patient had a good response to LC, beta-blocker, and glucocorticoid. This observation is corroborated by data in the literature showing improvement in TH levels in patients with GD after treatment for 36 weeks with LC 500 to 750 mg/day, associated or not with glucocorticoid and/or beta-blockers.…”

Section: Discussionmentioning

confidence: 53%

“…This observation is corroborated by data in the literature showing improvement in TH levels in patients with GD after treatment for 36 weeks with LC 500 to 750 mg/day, associated or not with glucocorticoid and/or beta-blockers. 20 LC is safe to treat patients with preoperative hyperthyroidism when ATDs are contraindicated. 20 There are few cases in the literature describing the use of lithium to treat thyrotoxicosis without planning for definitive treatment.…”

Section: Discussionmentioning

confidence: 99%

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Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

Rabelo

Paula

et al. 2019

Rev. Assoc. Med. Bras.

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SUMMARY INTRODUCTION: Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism. Antithyroid drugs (ATDs) are available as therapy. Agranulocytosis is a rare but potentially fatal complication of this therapy. In this study, we report agranulocytosis induced by propylthiouracil (PTU) in a patient with GD and the difficulties of clinical management. CASE: RNBA, male, 30 years old, with GD, treated with propylthiouracil (PTU). He progressed with pharyngotonsillitis. Then, PTU was suspended and antibiotic, filgrastim, propranolol, and prednisone were initiated. Due to the decompensation of hyperthyroidism, lithium carbonate, dexamethasone, and Lugol's solution were introduced. Total thyroidectomy (TT) was performed with satisfactory postoperative progression. DISCUSSION: We describe here the case of a young male patient with GD. For the treatment of hyperthyroidism, thioamides are effective options. Agranulocytosis induced by ATDs is a rare complication defined as the occurrence of a granulocyte count <500/mm3 after the use of ATDs. PTU was suspended, and filgrastim and antibiotics were prescribed. Radioiodine (RAI) or surgery are therapeutic alternatives. Due to problems with ATD use, a total thyroidectomy was proposed. The preoperative preparation was performed with beta-blocker, glucocorticoid, lithium carbonate, and Lugol solution. Cholestyramine is also an option for controlling hyperthyroidism. TT was performed without postoperative complications. CONCLUSION: Thionamide-induced agranulocytosis is a rare complication. With a contraindication to ATDs, RAI and surgery are definitive therapeutic options in GD. Beta-blockers, glucocorticoids, lithium carbonate, iodine, and cholestyramine may be an adjunctive therapy for hyperthyroidism.

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

Rabelo

Paula

et al. 2019

Rev. Assoc. Med. Bras.

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“…11,24,33 We found that the addition of lithium carbonate (200 mg/day) to basal MMI treatment reduced the thyroid hormone concentration of the present patient. Because anti-thyroid effects of lithium carbonate have been reported at doses of 600 to 900 mg/day, 11,33,34 we increased her lithium carbonate dose to 800 mg/day. However, inorganic iodine and corticosteroid were simultaneously administered; therefore, we do not know whether the escalation of the dose of lithium carbonate was the key change in therapy in the present case.…”

Section: Discussionmentioning

confidence: 99%

Very rare case of Graves’ disease with resistance to methimazole: a case report and literature review

et al. 2021

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Background Methimazole (MMI) is used to treat hyperthyroidism in Graves’ disease. It is rare to encounter patients in whom hyperthyroidism cannot be controlled using high doses of MMI. Case presentation: A 21-year-old woman was referred to our hospital because of MMI-resistant Graves’ disease. Although her MMI dose had been increased to 120 mg/day, her serum thyroid hormone concentration was too high to be measured. Additional therapy with lithium carbonate, and then with dexamethasone and inorganic iodine, was initiated. After 14 days, the patient’s serum thyroid hormone concentration normalized, while she was taking 150 mg/day MMI, 800 mg/day lithium carbonate, 6 mg/day dexamethasone and 306 mg/day inorganic iodine, and total thyroidectomy was then performed. The patient was discharged 8 days after the thyroidectomy and experienced no major complications. Conclusions We have presented a rare case of Graves’ disease that was resistant to high-dose MMI. Combination therapy of MMI with lithium carbonate, dexamethasone and inorganic iodine may represent a therapeutic option for the preoperative preparation of patients with MMI-resistant Graves’ disease.

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“…A Korean patient who was refractory to antithyroid drug treatment was successfully managed with cholestyramine [ 39 ], and serious hepatic dysfunction caused by the antithyroid drug was managed with hemodialysis [ 40 ]. The utility of potassium iodide [ 41 ] and lithium carbonate [ 42 ] as an adjuvant therapy has also been examined. Presentation of these difficult cases is vital when attempting to fill the gaps and cracks in existing knowledge and guidelines.…”

Section: Clinical Updates In Autoimmune Hyperthyroidismmentioning

confidence: 99%

Recent Advances in Autoimmune Thyroid Diseases

Yoo

Chung

2016

Endocrinol Metab

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Autoimmune thyroid disease (AITD) includes hyperthyroid Graves disease, hypothyroid autoimmune thyroiditis, and subtle subclinical thyroid dysfunctions. AITD is caused by interactions between genetic and environmental predisposing factors and results in autoimmune deterioration. Data on polymorphisms in the AITD susceptibility genes, related environmental factors, and dysregulation of autoimmune processes have accumulated over time. Over the last decade, there has been progress in the clinical field of AITD with respect to the available diagnostic and therapeutic methods as well as clinical consensus. The updated clinical guidelines allow practitioners to identify the most reasonable and current approaches for proper management. In this review, we focus on recent advances in understanding the genetic and environmental pathogenic mechanisms underlying AITD and introduce the updated set of clinical guidelines for AITD management. We also discuss other aspects of the disease such as management of subclinical thyroid dysfunction, use of levothyroxine plus levotriiodothyronine in the treatment of autoimmune hypothyroidism, risk assessment of long-standing antithyroid drug therapy in recurrent Graves' hyperthyroidism, and future research needs.

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Lithium Carbonate in the Treatment of Graves’ Disease with ATD-Induced Hepatic Injury or Leukopenia

Cited by 11 publications

References 34 publications

Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

Propylthiouracil-induced agranulocytosis as a rare complication of antithyroid drugs in a patient with Graves’ disease

Very rare case of Graves’ disease with resistance to methimazole: a case report and literature review

Recent Advances in Autoimmune Thyroid Diseases

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