Managing hyperthyroidism patients with unconventional therapy

DEAR EDITOR,

In their letter, Alvarez-Gamero and cols. (¹) comment on the position statement from the Thyroid Department of Brazilian Society of Endocrinology and Metabolism (SBEM) regarding managing thyroid disorders during the coronavirus disease (COVID-19) pandemic (²). Authors state that during hyperthyroidism treatment with antithyroid drugs, serious adverse effects can occur, and the use of unconventional antithyroid therapy such as compounds containing iodine, lithium carbonate, glucocorticoids, cholestyramine, and plasmapheresis is an option.

The antithyroid actions of lithium have been recognized for decades (³). However, the exact mechanisms are not well understood, and pieces of evidence show that lithium increases intrathyroidal iodine content, inhibits the coupling of iodotyrosine residues, and inhibits the release of T4 and T3 (³). There are frequent reports on treating Graves’ disease with lithium as an adjuvant in combination with radioiodine (⁴). However, studies reporting lithium as monotherapy in hyperthyroidism are frequently older and scarce (⁵).

Lithium is not a first-line treatment for hyperthyroidism due to its side effects and a narrow therapeutic range. The drawbacks of lithium therapy are no defined period of treatment duration and unknown rates of remission or relapse after lithium therapy (⁵).

In our opinion, lithium therapy (and other unconventional therapies, such as plasmapheresis) can be used in particular circumstances to improve thyroid function; however, it is a step to temporarily control hyperthyroidism until definitive treatment can be performed.

REFERENCES

• ¹
  Alvarez-Gamero JC, García-Ruiz VR, Paz-Ibarra JL. Use of unconventional antithyroid therapy in patients with thiamazole agranulocytosis in the context of the COVID-19 pandemic. Arch Endocrinol Metab. 2022;66(1):132-3.
• ²
  Martins JRM, Villagelin DGP, Carvalho GA, Vaisman F, Teixeira PFS, Scheffel RS, Sgarbi JA. Management of thyroid disorders during the COVID-19 outbreak: a position statement from the Thyroid Department of the Brazilian Society of Endocrinology and Metabolism (SBEM). Arch Endocrinol Metab. 2021 Nov 3;65(3):368-375.
• ³
  Suwansaksri N, Preechasuk L, Kunavisarut T. Nonthionamide Drugs for the Treatment of Hyperthyroidism: From Present to Future. Int J Endocrinol. 2018 Apr 22;2018:5794054.
• ⁴
  Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-1421.
• ⁵
  Ng YW, Tiu SC, Choi KL, Chan FK, Choi CH, Kong PS, Ng CM, Shek CC. Use of lithium in the treatment of thyrotoxicosis. Hong Kong Med J. 2006 Aug;12(4):254-9.

• Erratum

  Arch Endocrinol Metab. 2022;66(1):134
  Where you read:
  REFERENCES
  1. Gamero JA, Ruiz VG, Ibarra JP. Use of unconventional antithyroid therapy in patients with thiamazole agranulocytosis in the context of the COVID-19 pandemic. Arch Endocrinol Metab. 2022;66(1):XX-XX.
  Should read:
  REFERENCES
  1. Alvarez-Gamero JC, García-Ruiz VR, Paz-Ibarra JL. Use of unconventional antithyroid therapy in patients with thiamazole agranulocytosis in the context of the COVID-19 pandemic. Arch Endocrinol Metab. 2022;66(1):132-3.

Publication Dates

• Publication in this collection
  18 Mar 2022
• Date of issue
  Jan-Feb 2022

History

• Received
  04 Feb 2022
• Accepted
  05 Feb 2022