Bipolar affective disorder associated with thenar hypoplasia: is lithium safe?

Thenar hypoplasia has been described to occur as a part of radial longitudinal deficiency syndromes and occasionally related to Holt-Oram syndrome in which both cardiac and skeletal abnormalities co-occur. We describe a case with bilateral thenar hypoplasia, which resembles a milder variety of Holt-Oram syndrome, who developed bradycardia after exposure to lithium at therapeutic doses.