Lithium Induced Goiter

Read this to know more about lithium induced goiter. Lithium is used for the treatment of bipolar manic depressive disorder. Like iodine, lithium inhibits thyroid hormone release. Lithium treatment has been associated with the development of goiter.

lithium induced goiter

Lithium induces a marked decrease in the release of thyroid hormone (TH) from the thyroid. It seems to block colloid droplet formation in the apical pole of the thyrocyte and hence, inhibit TH release that is stimulated by thyrotropin and mediated by cyclic adenosine monophosphate (cAMP) within the thyrocyte.

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The exact action of lithium remains unknown.  Reports suggested either (1) lack of lithium effects cAMP synthesis or (2) lithium-induced inhibition of cAMP synthesis, later work in a strain of rat thyroid follicular cells (FRTL-5) and a cell line of Chinese hamster ovary fibroblasts stably transfected with the human thyrotropin receptor (CHO-R) showed significant potentiation by lithium of the cAMP response to exogenous thyrotropin.

Lithium-induced hypothyroidism occurs more frequently in patients with a history of thyroid gland damage (eg, following external radiation or iodine-131 therapy to treat hyperthyroidism).

Although the exact cause of lithium-induced thyrotoxicosis is not clear, some speculates that lithium may directly stimulate autoimmune reactions. On the other hand, thyroid autoimmunity is highly prevalent in patients with bipolar disorder.

Race of Lithium Induced Goiter

No racial predilection has been reported in lithium induced goiter.

Age / Sex of Lithium Induced Goiter

No difference in the incidence or prevalence of goiter formation in men and women has been reported.
Older patients are more prone to development of goiter.

Causes of Lithium Induced Goiter

Lithium carbonate is the direct cause of goiter formation.

Lithium Induced Goiter Signs and Symptoms

Patient is usually asymptomatic. Symptoms are similar to that of hypothyroidism or thyrotoxicosis is similar to that of iodine deficiency or excess respectively.
Thyroid gland enlargement is smooth, symmetrical and non tender.

Investigations of Lithium Induced Goiter

Serum thyrotropin: levels are higher than normal.
Circulating antithyroid peroxidase and anti Tg antibodies: Presence of these antibodies indicate positive results.
Serum free T4 and T3 test: Low levels indicate hypothyroidism
Imaging studies:
Thyroid ultrasound
123I uptake test: Increased
Perchlorate discharge test

Treatment for Lithium Induced Goiter

T4 (Levothyroxin) is the drug of choice.
Thyroid replacement therapy.
Thyroidectomy in rare cases.

Differential diagnosis of Lithium Induced Goiter

Non toxic goiter
Hashimotos thyroiditis
Subacute thyroiditis

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