Safety and Effectiveness of Lithium Therapy in Patients With Graves' Disease.

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-08-18 DOI:10.1111/cen.70022

Ümit Çavdar, Özlem Eren, Serkan Karaıslı, Mehmet Sercan Ertürk, Barış Önder Pamuk

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Abstract

Objective: Lithium is an established adjunct therapy in the management of hyperthyroidism, particularly when conventional antithyroid therapy is contraindicated. This study aimed to investigate its efficacy and safety in patients with Graves' disease.

Methods: This retrospective observational study was conducted on 14 patients who received lithium due to intolerance or adverse reactions to thionamides. Paired-samples t-tests and linear mixed-effects models were used to assess changes in thyroid hormones, renal markers, urinary concentration and electrolytes after lithium therapy.

Results: Lithium was initiated primarily due to allergic (35.7%) or hepatotoxic reactions (28,6%) to thionamides and 64.2% of patients ultimately underwent surgery or radioactive iodine therapy. Following a median lithium exposure of 37 days, significant reductions were observed in free T4 (2.58 ± 1.48 vs. 1.42 ± 1.06 ng/dL; p = 0.004) and free T3 (7.37 ± 2.70 vs. 4.88 ± 2.04 ng/L; p = 0.009). Urinary density decreased significantly (p = 0.016), suggesting early renal tubular effects. No significant changes were observed in serum sodium, potassium, or creatinine. Despite individual cases presenting hypercalcemia, there was no statistically significant change following lithium use (Δ = -0.12; p = 0.643; LMM F = 0.437, p = 0.730).

Conclusions: Lithium is effective in achieving rapid biochemical control of hyperthyroidism and may serve as a valuable bridging option for patients in whom antithyroid therapy is contraindicated or not tolerated. However, the potential for early renal concentration and calcium metabolism disturbances warrants vigilant monitoring.

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锂离子治疗Graves病患者的安全性和有效性。

目的：锂是治疗甲状腺功能亢进的一种辅助疗法，特别是当常规抗甲状腺治疗禁忌时。本研究旨在探讨其在Graves病患者中的疗效和安全性。方法：对14例因硫胺不耐受或不良反应接受锂治疗的患者进行回顾性观察研究。配对样本t检验和线性混合效应模型用于评估锂治疗后甲状腺激素、肾脏标志物、尿浓度和电解质的变化。结果：锂主要是由于对硫胺过敏（35.7%）或肝毒性反应（28.6%）引起的，64.2%的患者最终接受手术或放射性碘治疗。中位锂暴露37天后，观察到游离T4（2.58±1.48 vs. 1.42±1.06 ng/dL, p = 0.004）和游离T3（7.37±2.70 vs. 4.88±2.04 ng/L, p = 0.009）显著降低。尿密度明显降低（p = 0.016），提示早期肾小管效应。血清钠、钾和肌酐均未见明显变化。尽管个别病例出现高钙血症，但使用锂后无统计学意义变化（Δ = -0.12; p = 0.643; LMM F = 0.437, p = 0.730）。结论：锂可有效实现甲状腺功能亢进的快速生化控制，并可作为抗甲状腺治疗禁忌或不耐受患者的有价值的桥接选择。然而，早期肾浓度和钙代谢紊乱的可能性值得警惕监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.