eMedicine Specialties > Endocrinology > Thyroid

Goiter, Lithium-Induced: Follow-up

Author: Nicholas J Sarlis, MBBS, MD, PhD, FACP, Medical Director, Department of Oncology-US Medical Affairs Department, Sanofi-Aventis Pharmaceuticals
Coauthor(s): Boaz Hirshberg, MD, Associate Director, CVMD, Pfizer
Contributor Information and Disclosures

Updated: Dec 18, 2008

Follow-up

Further Inpatient Care

  • No further inpatient care is usually required.

Further Outpatient Care

  • A review of patient history, a physical examination, and an evaluation of thyrotropin levels are indicated within 6 months immediately after the initiation of lithium therapy and annually thereafter.
  • The treating physician must be aware that rare cases of thyrotoxicosis have been reported following discontinuation of lithium therapy.

Inpatient & Outpatient Medications

  • Levothyroxine sodium

Transfer

  • All care is typically performed in an ambulatory clinic setting; thus, no specific transfer requirements are applicable.

Deterrence/Prevention

  • For all patients on long-term lithium therapy, regular follow-up with an endocrinologist is indicated, starting within 6 months immediately after the initiation of lithium therapy and continuing annually thereafter (with thyrotropin levels and neck palpation).

Complications

  • Hypothyroidism
  • Hyperthyroidism (rare)
  • Compressive symptoms from goiter progression
  • Lithium toxicity

Prognosis

  • The long-term prognosis ranges from very good to excellent.

Patient Education

  • Regularly educate patients with regard to the possibility of thyroid dysfunction with long-term lithium treatment.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Thyroid Problems.

Miscellaneous

Medicolegal Pitfalls

  • Failure to follow up with patients by monitoring thyroid anatomy and function may lead to undiagnosed hypothyroidism or hyperthyroidism as well as to local symptoms from goiter progression.
 


More on Goiter, Lithium-Induced

Overview: Goiter, Lithium-Induced
Differential Diagnoses & Workup: Goiter, Lithium-Induced
Treatment & Medication: Goiter, Lithium-Induced
Follow-up: Goiter, Lithium-Induced
References
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References

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Further Reading

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Keywords

lithium-induced goiter, thyroid, bipolar, TSH, lithium, hypothyroidism, bipolar disorder, thyroid symptoms, goiter, hypothyroid, thyroid problems, thyroid nodules, thyroid gland, thyroid hormone, manic depression, hypothyroidism symptoms, mood disorders, mood disorder, manic depressive, bipolar treatment, lithium effects, lithium side effects, goiter lithium therapy, lithium treatment, thyroid-stimulating hormone, lithium toxicity, lithium-induced thyromegaly, thyrotropin, thyroglobulin, Tg, cyclic adenosine monophosphate, cAMP, euthyroid goiter, thyrotoxicosis, iodine, iodine deficiency, thyrocytes, bipolar manic-depressive disorder,

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Contributor Information and Disclosures

Author

Nicholas J Sarlis, MBBS, MD, PhD, FACP, Medical Director, Department of Oncology-US Medical Affairs Department, Sanofi-Aventis Pharmaceuticals
Nicholas J Sarlis, MBBS, MD, PhD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Physicians, American Federation for Medical Research, American Head and Neck Society, American Medical Association, American Society for Therapeutic Radiology and Oncology, American Society of Clinical Oncology, American Thyroid Association, Association for Psychological Science, Endocrine Society, European Society for Medical Oncology, New York Academy of Sciences, and Royal Society of Medicine
Disclosure: Sanofi-Aventis Salary Employment

Coauthor(s)

Boaz Hirshberg, MD, Associate Director, CVMD, Pfizer
Boaz Hirshberg, MD is a member of the following medical societies: American Dietetic Association
Disclosure: Nothing to disclose.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Don S Schalch, MD, Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics
Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical Research, and Endocrine Society
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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