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Research Article| Volume 8, ISSUE 1, P63-66, January 1990

Lithium toxicity and myxedema coma in an elderly woman

  • Robert Santiago
    Correspondence
    Reprint address: Dr. Robert Santiago, University of Cincinnati, Department of Emergency Medicine, 234 Goodman Street, Cincinnati, OH 45267-0769
    Affiliations
    Department of Emergency Medicine and Clinical Toxicology, Division of Pulmonary and Critical Care Medicine, University of Cincinnati Medical Center, USA
    Search for articles by this author
  • Mitchell C. Rashkin
    Affiliations
    Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Cincinnati Medical Center USA
    Search for articles by this author
DOI:https://doi.org/10.1016/0736-4679(90)90390-H
Lithium toxicity and myxedema coma in an elderly woman
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      Abstract

      The development of hypothyroidism as a side effect of lithium therapy is a well recognized phenomenon. However, the presentation of myxedemn coma after lithium intoxication has not been previously documented. In this case lithium toxicity may have exacerbated preexisting hypothyroidism to the point of respiratory arrest. Based on this case, we recommend periodic monitoring of thyroid function in an effort to detect preexisting hypothyroidism or lithium-induced hypothyroidism.

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      References

        • Lydiard R.D.
        • Gelenberg A.J.
        Hazards and adverse effects of lithium.
        Ann Rev Med. 1982; 33: 327-344
        • Macfie A.C.
        Lithium poisoning precipitated by diuretics.
        Brit Med J. 1975; 1: 516
        • Dyson E.H.
        • Simpson D.
        • Prescott L.F.
        • Proudfoot A.T.
        Self-poisoning and therapeutic intoxication with lithium.
        Human Toxicol. 1987; 6: 325-329
        • Dorevitch A.
        • Baruch E.
        Lithium toxicity induced by combined amiloride HCLrhydrochlorothiazide administration (letter).
        Am J Psychiatry. 1986; 143: 257-258
        • El-Mallakh R.S.
        Treatment of acute lithium toxicity.
        Vet Hum Toxicol. 1984; 26: 31-35
        • Berens S.C.
        • Bernstein R.S.
        • Robbins J.
        • Wolff J.
        Antithyroid effects of lithium.
        J Clin Invest. 1970; 49: 1357-1367
        • Temple R.
        • Berman M.
        • Robbins J.
        • Wolff J.
        The use of lithium in the treatment of thyrotoxicosis.
        J Clin Invest. 1972; 51: 274-656
        • Singer I.
        • Rotenberg D.
        Mechanisms of lithium action.
        New Engl J Med. 1973; 2: 254-260
        • Maarbjerg K.
        • Vestergaard P.
        • Schou M.
        Changes in serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) during prolonged lithium treatment.
        Acta Psychiatry Scand. 1987; 75: 217-221
        • Yassa R.
        • Saunders A.
        • Nastase C.
        • Camille Y.
        Lithium-induced thyroid disorders. A prevalence study.
        J Clin Psychiatry. 1988; 49: 14-16
        • Lazarus J.H.
        Endocrine and metabolic effects of lithium.
        in: Plenum Medical Book Co, 1986: 99-125
        • Lindstedt G.
        • Nilsson L.
        • Walinder J.
        • Skott A.
        • Ohman R.
        On the prevalence, diagnosis and management of lithium-induced hypothyroidism in psychiatric patients.
        Brit J Psychiat. 1977; 130: 452-458
        • Villeneuve A.
        • Gautier J.
        • Jus A.
        • Perron D.
        Effect of lithium on thyroid in man.
        Lancet. 1973; 1: 502
        • Tunbridge W.M.G.
        • Evered D.C.
        • Hall R.
        • et al.
        The spectrum of thyroid disease in a community. The Whickham survey.
        Clin Endocrinol. 1977; 7: 481-493
        • Jefferson J.W.
        Primer of lithium therapy.
        in: Williams and Wilkins, Philadelphia1977: 169-205
        • Tappy L.
        • Randin J.P.
        • Schwed P.
        • Wertheimer J.
        • LemarchandBeraud T.H.
        Prevalence of thyroid disorders in psychogeriatric inpatients.
        J Am Geriatric Soc. 1987; 35: 526-531
        • Livingston E.H.
        • Hershman J.M.
        • Sawin C.T.
        • Yoshikawa T.T.
        Prevalence of thyroid disease and abnormal thyroid test in older hospitalized and ambulatory persons.
        J Am Geriatric Soc. 1987; 35: 109-114
        • Tyler K.L.
        • Tyler H.R.
        Differentiating organic dementia.
        Geriatrics. 1984; 39: 38-52
        • Shore D.
        • Overman C.
        • Wyatt R.J.
        Improving accuracy in the diagnosis of Alzheimer's disease.
        J Clin Psychiatry. 1983; 44: 207-212
        • Larson E.B.
        • Reifler B.V.
        • Sumi S.M.
        • Canfield C.G.
        • Chinn N.M.
        Diagnostic tests in the evaluation of dementia. A prospective study of 200 elderly outpatients.
        Arch Intern Med. 1986; 146: 1917-1922
        • Larson E.B.
        • Reifler B.V.
        • Featherstone H.J.
        • English D.R.
        Dementia in elderly outpatients. A prospective study.
        Ann Int Med. 1984; 100: 417-423
        • Lesar T.S.
        • Tollefson G.
        Lithium therapy: careful workup, close follow-up to avoid toxicity.
        Postgrad Med. 1984; 75: 269-286
        • Schou M.
        • Amdisen A.
        • Trap-Jensen J.
        Lithium poisoning.
        Am J Psychiatry. 1968; 125: 520-527
        • Smigan L.
        • Wahlin A.
        • Jacobsson L.
        • von Knorring L.
        Lithium therapy and thyroid function tests.
        Neuropsychobiology. 1984; 11: 39-43
        • Emerson C.H.
        • Dyson W.L.
        • Utiger R.D.
        Serum thyrotropin and thyroxine concentrations in patients receiving lithium carbonate.
        J Clin Endocrinal Metab. 1973; 36: 338-346
        • Boehm T.M.
        • Burman K.D.
        • Barnes S.
        • Wartofsky L.
        Lithium and iodine combination therapy for thyrotoxicosis.
        Acta Endocrinologica. 1980; 94: 174-183
        • Bovier P.
        • Toutoungi M.
        • Hilleret H.
        • Dick P.
        • Tissot R.
        Irreversible hypothyroidism following prolonged use of lithium.
        Human Psychopharmacology. 1987; 2: 243-245
        • Shopsin B.
        Effects of lithium on thyroid function.
        Diseases of the nervous system. 1970; 31: 237-244
        • Schou M.
        • Amdisen A.
        • Eskjaer Jensen S.
        • Olsen T.
        Occurrence of goiter during lithim treatment.
        Brit Med J. 1968; 3: 710-713
        • Reisberg B.
        • Gershon S.
        Side effects associated with lithium therapy.
        Arch Gen Psychiatry. 1979; 36: 879-887
        • Cairns S.R.
        • Wolman R.
        • Lewis J.G.
        Persistent nephrogenic diabetes insipidus, hyperparathyroidism, and hypothyroidism after lithium treatment.
        Brit Med J. 1985; 290: 516-517
        • Sinaikin P.
        • Gold M.S.
        Endocrinology and depression II: Thyroid function.
        in: Cameron O.G. Presentation of depression. Wiley-Interscience Publication, New York1987: 275-290
        • Clark B.G.
        • Vestal R.E.
        Adverse drug reactions in the elderly: case studies.
        Geriatrics. 1984; 39: 53-66

      Article info

      Publication history

      Accepted: July 11, 1989
      Received in revised form: June 19, 1989
      Received: March 10, 1989

      Identification

      DOI: https://doi.org/10.1016/0736-4679(90)90390-H

      Copyright

      © 1990 Published by Elsevier Inc.

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