A patient on chronic lithium therapy may develop thyroid dysfunction.

Clinical features:

(1) history of therapy with lithium

(2) evidence of hyperthyroidism or hypothyroidism

(3) change in serum TSH (elevated in hypothyroidism, decreased in hyperthyroidism)

(4) variable presence of antithyroid antibodies


Hypothyroidism is more common.


Lithium therapy has been associated with a silent thyroiditis and hyperthyroidism. Over time damage to the thyroid gland may result in hypothyroidism.


The differential diagnosis is thyroid dysfunction unrelated to lithium therapy. Improvement after discontinuation of lithium would support a drug-induced toxicity.

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