Lithium-Induced Goiter Clinical Presentation

Updated: Feb 27, 2015
  • Author: Nicholas J Sarlis, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Presentation

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; however, because patients have either bipolar affective disorder or mania, symptoms of thyroid dysfunction may be misinterpreted or missed altogether, because these 2 classes of conditions share several similarities with regard to clinical presentation.

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Physical

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.

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Causes

Lithium carbonate is the direct cause of goiter formation. The following are contributing factors in goiter formation:

  • Iodide deficiency

  • Prior or subclinical autoimmune thyroid disease

  • Prior131 I-induced or external radiation – induced thyroid gland damage

  • Possible concomitant exposure to environmental and dietary goitrogens other than lithium (eg, polychlorinated biphenyls [PCBs], thiocyanate, naturally occurring thioglycosides and glucosinolates found in vegetables in the Brassica species, such as Brussels sprouts).

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