Lithium-Induced Goiter Clinical Presentation

Updated: Apr 13, 2020
  • Author: Nicholas J Sarlis, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Presentation

History and Physical Examination

History

Patients are usually asymptomatic. Documenting the duration of lithium therapy is important. Symptoms of hypothyroidism or thyrotoxicosis do not differ from those observed in states of thyroid deficiency or excess due to other causes and include ethargy, cognitive difficulties, depression, weight gain, dry skin, and cold intolerance. In addition, a number of these symptoms overlap with depression symptoms of bipolar disorder, as well as side effects from lithium, making diagnosis difficult in the absence of thyroid function tests. [3, 7]

Physical Examination

The thyroid gland enlargement is smooth, symmetrical, and nontender. Because goiter nodules are usually small, dyspnea due to laryngotracheal pressure is usually absent. The physical signs of hypothyroidism or thyrotoxicosis do not differ from those observed in states of thyroid deficiency or excess, respectively, attributable to other causes.