Division of Endocrinology, Diabetes and Metabolism, Parkview Medical Center, Pueblo, CO, USA.
Am J Case Rep. 2022 Apr 28;23:e935789. doi: 10.12659/AJCR.935789.
BACKGROUND The therapeutic approach to Graves' disease (GD) comprises thionamides, radioiodine ablation, or surgery as first-line therapy, and cholestyramine and oral iodine as second-line therapies. The role of lithium (Li) in GD as a primary or adjunctive therapy remains contentious. We present a case of GD managed by Li therapy with oral iodine solution. CASE REPORT A 26-year-old man, admitted with acute blast crisis secondary to chronic myeloid leukemia (CML), reported palpitations, 40-lb weight loss, heat intolerance, and fatigue. An examination revealed sinus tachycardia, elevated body temperature, and thyromegaly. Laboratory evaluation confirmed hyperthyroidism (TSH <0.005 mcIU/l, FT4 5.57 ng/dl, TT3 629 ng/dl) secondary to GD (TRAb >40 IU/l, TSIg 178%). Thionamides and surgery were contraindicated due to pancytopenia from a blast crisis. Inability to maintain post-radiation precautions precluded use of RAI. Cholestyramine was attempted and discontinued due to nausea. We introduced oral Li carbonate with oral iodine, which the patient tolerated. Thyroid functions improved with therapy (TSH 0.007 mcIU/l, FT4 0.82 ng/dl, TT3 122 ng/dl) with stable Li level (0.5-0.8 mmol/l). CONCLUSIONS Li inhibits iodine uptake through interference with sodium-iodide symporter and tyrosine iodination, thyroglobulin structure changes, peripheral deiodinase blockage, and preventing TSH and TSIg stimulation. Our case shows that a low therapeutic level of Li, in combination with oral iodine, can suppress thyroid overactivity without adverse effects. We suggest that low-dose Li carbonate is a safe and effective adjunctive antithyroid medication to be considered if primary therapies for hyperthyroidism are unavailable.
Graves 病（GD）的治疗方法包括硫脲类药物、放射性碘消融或手术作为一线治疗，考来烯胺和口服碘作为二线治疗。锂（Li）在 GD 中的作用作为主要或辅助治疗仍然存在争议。我们报告了一例 GD 患者，采用 Li 治疗联合口服碘溶液进行治疗。
一名 26 岁男性，因慢性髓性白血病（CML）继发急性爆发性危机入院，报告有心悸、40 磅体重减轻、怕热和疲劳。体格检查发现窦性心动过速、体温升高和甲状腺肿大。实验室评估证实甲状腺功能亢进（TSH<0.005mcIU/l，FT4 5.57ng/dl，TT3 629ng/dl）继发于 GD（TRAb>40IU/l，TSIg 178%）。由于爆发性危机导致全血细胞减少，硫脲类药物和手术均被禁忌。由于放射性后预防措施无法维持，因此无法使用 RAI。考来烯胺因恶心而尝试并停止。我们引入了口服碳酸锂和口服碘，患者耐受。甲状腺功能随着治疗而改善（TSH 0.007mcIU/l，FT4 0.82ng/dl，TT3 122ng/dl），Li 水平稳定（0.5-0.8mmol/l）。
Li 通过干扰钠碘转运体和酪氨酸碘化、甲状腺球蛋白结构改变、外周脱碘酶阻断以及防止 TSH 和 TSIg 刺激来抑制碘摄取。我们的病例表明，低治疗剂量的 Li 联合口服碘可以抑制甲状腺过度活动而没有不良反应。我们建议，如果无法使用治疗甲状腺功能亢进的主要方法，低剂量碳酸锂是一种安全有效的辅助抗甲状腺药物。
