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Lithium is a drug which may cause thyroid dysfunction. The most widely known dysfunctions associated with long-term lithium treatment are goiter and hypothyroidism. Lithium associated thyrotoxicosis is however uncommon. This current review explores the common mechanisms of lithium induced hyperthyroidism. METHODS A systematic review of database was made using PubMed. The search keywords used were lithium therapy, thyroid side effects, thyroid dysfunction mechanism, hyperthyroidism, thyrotoxicosis. RESULTS Lithium induced hyperthyroidism is uncommon, the incidence rate varying from 0.1% to 1.7%. The mechanisms of lithium associated hyperthyroidism are uncertain. Recent studies have proved that high proportion of investigated patients experienced transient thyrotoxicosis and painless thyroiditis. Different mechanisms have been discussed, including autoimmune inflammation, direct cellular destruction, susceptible individuals with preexisting Grave's disease , a rebound effect of lithium therapy interruption… The pathogenesis of painless thyroiditis is unclear but different studies suggest a possible direct toxic effect of lithium on the thyroid gland. Lithium stimulates thyroid autoimmunity: lithium treated patients presented more positive antithyroid peroxidase antibodies than not lithium treated patients. This could be explained by an increased activity of Bcell lymphocyte activity and reduced ratios of suppressor to cytotoxic T-cell lymphocyte. CONCLUSION Long term lithium treated patients should be monitored for the development of thyroid dysfunction. It's recommended to perform thyroid function test, thyroid antibodies and thyroid ultrasonography with a closer follow-up for lithium-treated patients with thyroid antibodies, or family history of thyroid disease.

all by invitation) BIRMINGHAM, ALA.The first case of intratracheal goitre was reported in the German literature in 1875 by Ziemssen who treated a thirty year old male whose chief complaint was dyspnea. The patient suffered from an intratracheal tumor measuring 2x1x1 cm which communicated at the level of the cricoid cartilage with an exterior nodular goitre. The first successful resection of this lesion was performed by Heisse in 1888, on a 25 year old German male who had an intratracheal tumor at the level of the first tracheal cartilage. The lesion was dealt with by tracheal fissure and curettement. The first mention of this lesion in the American literature is by Freer in 1901, who described the lesion in a thirty-two year old female whose intratracheal tumor was treated by endoscopic coagulation, with tracheostomy required. Theisen, in 1902, observed a thirty-five year old female with an intratracheal lesion which produced dyspnea and which was treated by tracheal fissure.The sporadically occurring reports in the literature are similar in content and implication and the story is a repeated one, of patients, usually young, complaining of dyspnea and presenting, on physical examination, an intratracheal or intralaryngeal tumor, the surgical management of which is fraught with some degree of difficulty.The present case is of a thirty-eight year old Negro female who was admitted to the University of Alabama Medical Center with a history of hemoptysis for two days prior to admission. Within the past several months, she had had two previous episodes of hemoptysis. Her past history revealed a thyroidectomy for nodular goitre, thirteen years prior to the present admission. Respiratory wheezing accom-