How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?
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.
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How do you medically manage uncontrolled Graves' disease in a patient awaiting surgery who is intolerant to methimazole and PTU and refusing RAI?
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1 Answer
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Endocrinology · Johns Hopkins Outpatient Endocrinology
Answered on
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.
Therefore, I do not think you need to treat this patient with lithium, risking lithium toxicity, to prepare...
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