Autoimmune thyrotoxicosis during lithium therapy in a patient with manic-depressive illness

Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder

“…Whilst psychiatrists prescribing lithium for bipolar affective disorder can expect the development of hypothyroidism in up to 30% of patients (5, 6), the emergence of thyrotoxicosis in relation to lithium treatment remains a paradoxical, rare and poorly explained phenomenon. Our literature search has yielded about 50 previously reported cases of lithium‐associated hyperthyroidism, some of these occurring on lithium withdrawal but none on dose reduction (3–16). Statistical analysis however has shown that long‐term lithium therapy is associated with an increased risk of thyrotoxicosis (4).…”

“… an autoimmune thyroid disease triggered off by lithium (5–9, 16); disturbed iodine kinetics with escape phenomenon and ‘overflow’ of thyroid hormone after expansion of the intrathyroidal iodine pool (3, 4, 6, 12, 13); a Jod–Basedow‐like phenomenon (3); direct damage by lithium of thyroid follicular cells with subsequent release of thyroglobulin into the circulation (10, 14); coincidental Graves’ disease (16) or other coincidental hyperthyroidism. …”

Association between lithium use and thyrotoxicosis caused by silent thyroiditis

“…The most common form of silent thyroiditis is postpartum thyroiditis. Case reports describing thyrotoxicosis concomitant with lithium administration primarily describe patients with Graves' disease or toxic nodular goitre (McDermott et al ., 1986; Yassa et al ., 1988; Brownlie & Wells, 1990; Lee et al ., 1992; Sirota et al ., 1992; Persad et al ., 1993; Barclay et al ., 1994; Becerra‐Fernandez, 1995). However, some of these patients were diagnosed with spontaneously resolving thyrotoxicosis, probably silent thyroiditis.…”

Recognizing thyrotoxicosis in a patient with bipolar mania: a case report

“…Several mechanisms have been described regarding how lithium disrupts the hypothalamic-pituitary-thyroid axis, thus leading to thyroid dysfunction [ 1 , 2 , 4 , 6 ]. Transient hypothyroidism has been observed in up to 30% of patients treated with lithium [ 9 ].…”

“…Multiple cases of patients with thyrotoxicosis presenting with symptoms clinically indistinguishable from bipolar mania have been reported [ 1 - 8 ]. Moreover, lithium for the management of preexisting bipolar disorder has many known effects on thyroid function [ 1 , 2 , 4 , 6 , 8 - 10 ]. We report the case of a patient whose chronic lithium was discontinued owing to other concerns and who then presented with manic and psychotic symptoms apparently related to thyrotoxicosis.…”