Endocrine Abstracts

Introduction: Thionamides are first line treatment in the management of thyrotoxicosis; nevertheless several weeks of treatment is needed before euthyroidism is restored. This delayed and gradual action makes thionamides insufficient as sole treatment when acute control of the hyperthyroid status is mandatory, hence the need for potent yet rapid acting adjuvant antithyroid agent. Lithium is a monovalent cation that inhibits thyroid iodine uptake and hormone release with maximum effect in 3–5 days making it a suitable adjuvant agent to conventional preoperative antithyroid treatment.

We here report a series of three cases where lithium was used successfully as adjuvant treatment in the acute preoperative control of hyperthyroidism prior to emergency thyroid surgery.

Case 1: 28 years female with young family and severe symptomatic Graves hyperthyroidism resistant to high doses of carbimazole was admitted for primary thyroid surgery. She was treated with Lithuim 1200 mg dose in addition to her current carbimazole treatment, KI and steroids. T₃ levels were down by 78% on day 8 and she underwent uneventful total thyroidectomy with good recovery.

Case 2: 32 years old female admitted acutely with large toxic retrosternal goitre, stridor and near complete dysphagia. She was counselled for urgent total thyroidectomy. Lithium tablets were crushed along with regular pre operative medication. On day eight T₃ and T₄ were down by 70 and 51%. She underwent an uncomplicated total thyroidectomy.

Case 3: 51 years female admitted with Grave’s thyrotoxicosis and progressive ophthalmopathy resistant to high dose carbimazole and oral steroids. Lithium was added at a dose of 800 mg od, by day six T₃ was down by 70.9% and subsequently underwent a successful total thyroidectomy.

Conclusion: Our series demonstrates that euthyroidism can be restored quickly, effectively, and safely with short-term co-administration of lithium (800–1200 mg/day) to conventional antithyroid agents in the acute preoperative preparation of thyrotoxic patients.