Abstract 4: Lithium in Graves' disease: Role for endocrine-nuclear synergy?

Background: Lithium, a drug that is predominantly used in psychiatric practice, also finds therapeutic use as a second-line agent in endocrine conditions like Graves' disease and SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone). Case Report: We had a young female present to us with Graves' disease and having a precarious renal function (solitary kidney). The patient developed hypersensitivity reaction and hepatotoxicity with methimazole, due to which the anti-thyroid drug had to be withdrawn. As an alternative option, lithium was used successfully to control her hyperthyroidism. Patient became euthyroid within 20 days of starting lithium. Subsequently, the patient underwent successful radioactive iodine ablation (RAIA) under lithium cover, tapering it gradually. Currently, the patient is euthyroid on levothyroxine. The renal functions remained normal. We illustrate this case to discuss therapeutic uses of Lithium in non-psychiatric conditions, specifically Graves' disease. Conclusion: Short-term lithium usage can serve as a valuable alternative medical therapy for effectively controlling hyperthyroidism, especially in certain subgroups like the presence of complications with thionamide use, cardiovascular disease, elderly population, and large goiters. It can also serve as an adjunct to RAI therapy, providing interim control of thyrotoxicosis and also enhancing the efficacy of RAI therapy with higher cure rates, faster control, and even attenuation of the surge in thyroid hormones post-RAIA.