Lithium Toxicity Precipitated by Thyrotoxicosis Due to Silent Thyroiditis: Cardiac Arrest, Quadriplegia, and Coma

• DOI: 10.1089/thy.2012.0140
• Publication Date: 2012-12-04T20:19:32Z
• Authors: Yoshinori Sato; Katsumi Taki; Yuki Honda; Shoichiro Takahashi; Ashio Yoshimura
• Keywords: Coma (optics); Cardiac toxicity

Lithium is widely used to treat bipolar disorders. toxicity generally caused by inappropriately high doses of lithium or impaired excretion. Most eliminated via the kidneys and, since thyroid hormone increases tubular reabsorption lithium, thyrotoxicosis could contribute development toxicity. We report a case severe that was apparently precipitated onset resulting from silent thyroiditis and dehydration.The patient 64-year-old woman who admitted for muscle weakness in lower extremities, diarrhea, palpitations. She had disorder being treated with carbonate, which she discontinued one week before admission. Her circulating levels been monitored yearly. Early her admission dehydrated febrile episodes, paroxysmal atrial fibrillation, weakness. Initially, fluid therapy started, but lost consciousness cardiac arrest 2 minutes due prolonged sinus arrest. Chest compression manual artificial ventilation were performed, body surface pacing started. Serum markedly elevated 3.81 mEq/L (therapeutic range, 0.4-1.0 mEq/L), increased (free triiodothyronine, 8.12 pg/mL; free thyroxine, 4.45 ng/dL), while thyrotropin (TSH) suppressed (<0.01 μIU/mL). Hemodialysis temporary pacemaker inserted bradycardia. The serum thyroglobulin 4680 ng/mL (reference <32.7 ng/mL). A TSH receptor antibody test negative. Glucocorticoid inorganic iodine (100 mg) administered continued until day 11. However, neurological symptoms deteriorated floppy quadriplegia deep coma. gradually recovered. On 36, discharged without any thyrotoxicosis.A taking developed setting what seemed likely be recent thyroiditis.Thyrotoxicosis may contributing cause toxicity, particularly if it abrupt even cessation renal function compromised. Thyroid should assessed immediately patients suspected