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.

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...

at Access Endocrinology Llc
Agree with Dr. @Dhir - can use beta blockers and S...

Please select the option that best describes you:

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

Related Questions