"Critical Care A Day"
Scenario; 55 year old male with a recent history of thyroid cancer is admitted to ICU from ED with lithium toxicity. Patient has no psychiatric history but according to wife lithium has been prescribed as an adjuvant treatment for his thyroid cancer.
Answer: Objective of above question is two folds.
First to emphasize the risk of thyroid dysfunction with lithium treatment. Second is to describe the use of lithium in thyroid cancer. Lithium is known to cause goiter, hypothyroidism, and hyperthyroidism. Lithium has a triple effect on the thyroid.
1. It increases the intrathyroid iodine content,
2. It inhibits the coupling of iodotyrosine residues to form T4 and T3, and
3. It inhibits the release of T4 and T3
Taking advantage of these effects, lithium is used in thyroid cancer after treatment with iodine-131. It may increase the retention of the isotope by cancer tissue.
1. Burrow GN, Burke WR, Himmelhoch JM, et al. Effect of lithium on thyroid function. J Clin Endocrinol Metab 1971; 32:647.
2. Liu YY, van der Pluijm G, Karperien M, et al. Lithium as adjuvant to radioiodine therapy in differentiated thyroid carcinoma: clinical and in vitro studies. Clin Endocrinol (Oxf) 2006; 64:617.