How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?

Topics: Endocrinology • Thyroid Disorders

Patient had intolerance to methimazole and then developed agranulocytosis with PTU. FT4 is 2.9 (upper normal range is 1.7). I have started the patient on lithium 300 mg daily. Are there other treatment options I should consider? If Lithium is best choice, how do I titrate dose and monitor labs to avoid lithium toxicity.

Answer from: at Community Practice

Although this seems like a difficult situation, one must remember that in the past, patients were prepared for surgery with beta-blockers + KI, with excellent outcomes.Feek et al., PMID 6892650Therefore, I do not think you need to treat this patient with lithium, risking lithium toxicity, to prepare...

Comments

at First State Endocrinology Pa
I have personally used lithium in 3-4 other patien...

at Milwaukee Va Medical Center
I would use SSKI in a patient who was starting ant...

at Washington DC VA Medical Center
Although rarely used, Lithium can be a viable opti...

at Tidelands Health Endocrinology
I have used Betablockers and KI prior to total thy...

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