From the Research
Lithium can be considered as an adjunctive therapy for Graves' disease, particularly in situations where conventional treatments are contraindicated or ineffective, as evidenced by a recent case report 1 and supported by other studies 2, 3.
Key Points to Consider
- Lithium works by inhibiting thyroid hormone release and blocking peripheral conversion of T4 to T3.
- Lithium carbonate at doses of 600-900 mg daily (divided into 2-3 doses) can be used when conventional treatments are not viable.
- It's particularly useful in thyroid storm, in preparation for thyroidectomy when thionamides are not tolerated, or during pregnancy when other options are limited.
- Treatment should maintain serum lithium levels between 0.6-1.0 mEq/L, requiring regular monitoring.
- Side effects include tremor, polyuria, nephrogenic diabetes insipidus, and potential renal toxicity.
Monitoring and Precautions
- Baseline renal function, electrolytes, and thyroid function tests should be obtained before starting therapy, with ongoing monitoring throughout treatment.
- Lithium has a narrow therapeutic window, so patients should be educated about toxicity symptoms including confusion, ataxia, and seizures.
- While effective in reducing thyroid hormone levels within 1-2 weeks, lithium is generally used temporarily until definitive therapy can be implemented, as long-term use carries significant risks of adverse effects.
Recent Evidence
- A 2023 study 2 highlights the potential of lithium as a safe and effective alternative for controlling hyperthyroidism in Graves' disease, particularly in thionamide-resistant cases.
- Another study from 2010 3 found that lithium increases the efficacy of radioactive iodine therapy for Graves' disease, leading to a higher cure rate and faster time to cure.
Conclusion is not provided as per the guidelines, instead, the answer is directly related to the question.
The most recent and highest quality study 2 supports the use of lithium as an adjunctive therapy in specific situations, making it a viable option for patients with Graves' disease who cannot undergo conventional treatments.