Table of ContentsView AllTable of ContentsGoiterHypothyroidismHyperthyroidismDiagnosing Lithium-Induced Thyroid Dysfunction
Table of ContentsView All
View All
Table of Contents
Goiter
Hypothyroidism
Hyperthyroidism
Diagnosing Lithium-Induced Thyroid Dysfunction
People with bipolar disorder, sometimes referred to as manic depression, are often surprised to learn that thyroid problems are a side effect of taking lithium, which is a medication used to treat this mental health condition. This can be a concern for those who already have been diagnosed with thyroid disease, as well as those who haven’t—but now run the risk because of their lithium use.
Verywell / Brianna Gilmartin
Lithium has several biological effects on the thyroid, some of which include:
Due to these effects and others, lithium may causegoiter(an enlarged thyroid), as well as hypothyroidism (an underactive thyroid). It is also linked to the development of hyperthyroidism (overactive thyroid) in some people, although this is rare.
Goiter, the term for an enlarged and swollen thyroid gland, is the most common thyroid-related side effect of lithium, occurring in approximately 40 percent to 50 percent of all patients.Goiter usually develops within the first two years of lithium treatment and causes a thyroid gland that is approximately twice the normal size.
Goiter formation is believed to occur as a result of lithium-induced changes in the function of certain hormones and molecules, including insulin-like growth factor and tyrosine kinase.
Treatment with thyroid hormone replacement medication (levothyroxine) may be used to decrease the size of the goiter; surgery is needed if the goiter becomes too large and narrows the airway.
Hypothyroidismis estimated to occur in about 20 percent to 30 percent of all patients taking lithium. It is most common in women over the age of 45 and in people with a family history of thyroid disease. As with goiter, hypothyroidism generally develops within the first two years of lithium treatment.
Hypothyroidism from lithium use can occur in the presence or absence of a goiter and is usually subclinical, meaning a person has an elevated thyroid stimulating hormone (TSH) level but normal T4 and T3 levels. A small percentage of patients, however, will develop overthypothyroidismfrom lithium therapy, with its typical signs and symptoms.
Treatment of subclinical or overt lithium-induced hypothyroidism entails taking thyroid hormone replacement medication.
What Is a Goiter?
Treatment of lithium-induced hyperthyroidism involves taking an anti-thyroid drug. If a person develops lithium-induced Graves' disease (autoimmune hyperthyroidism), treatment with radioactive iodine or surgical removal of the thyroid may be necessary.
Benefits vs. RisksLithium is often critical in the management of bipolar disorder, so the risk of developing thyroid problems should not rule out the use of this medication. It is important, however, to see your healthcare provider regularly for thyroid function testing and report any new symptoms right away.
Benefits vs. Risks
Lithium is often critical in the management of bipolar disorder, so the risk of developing thyroid problems should not rule out the use of this medication. It is important, however, to see your healthcare provider regularly for thyroid function testing and report any new symptoms right away.
1:39Click Play to Learn All About Lithium
1:39
Click Play to Learn All About Lithium
Before you are prescribed lithium, your healthcare provider should perform the following standard tests used to diagnose thyroid dysfunction.
Clinical Examination
Your healthcare provider will ask about your symptoms and perform several other clinical assessments.Tests include:
Blood Tests
Thyroid blood tests are used to measure levels of these substances:
Thyroid Blood Tests: Types and What Results Mean
Radioactive Iodine Uptake Test
In addition to the radioactive iodine uptake, a thyroid scan may be obtained, which shows a picture of the thyroid gland.
If you are taking lithium, your healthcare provider should reevaluate your thyroid function using these same tests every six to 12 months—sooner if you begin to show symptoms that suggest you have thyroid dysfunction.
If thyroid dysfunction occurs while on lithium, treatment of the underlying thyroid problem is warranted, but discontinuation of lithium is not generally necessary.Instead, your psychiatrist will continue to manage your lithium and bipolar disease, and your primary care healthcare provider or endocrinologist (a healthcare provider who specializes in thyroid diseases) will manage and treat your thyroid problem.
A Word From Verywell
The link between lithium use and thyroid dysfunction, especially goiter and hypothyroidism, is well-known, but don’t be scared off from taking lithium for your bipolar disease because of this potential side effect. Lithium-induced thyroid problems can be easily detected and effectively treated.
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lazarus JH.Lithium and thyroid.Best Pract Res Clin Endocrinol Metab. 2009;23(6):723-33. doi:10.1016/j.beem.2009.06.002Cleveland Clinic.Goiter: Management and Treatment.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yKibirige D, Luzinda K, Ssekitoleko R.Spectrum of lithium induced thyroid abnormalities: a current perspective.Thyroid Res. 2013;6(1):3. Published 2013 Feb 7. doi:10.1186/1756-6614-6-3University of Washington Department of Medicine.Techniques: Thyroid Exam.National Institute of Diabetes and Digestive and Kidney Diseases.Thyroid Tests.Radiological Society of North America.Thyroid Scan and Uptake.Joffe RT.How should lithium-induced thyroid dysfunction be managed in patients with bipolar disorder?J Psychiatry Neurosci.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Lazarus JH.Lithium and thyroid.Best Pract Res Clin Endocrinol Metab. 2009;23(6):723-33. doi:10.1016/j.beem.2009.06.002Cleveland Clinic.Goiter: Management and Treatment.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yKibirige D, Luzinda K, Ssekitoleko R.Spectrum of lithium induced thyroid abnormalities: a current perspective.Thyroid Res. 2013;6(1):3. Published 2013 Feb 7. doi:10.1186/1756-6614-6-3University of Washington Department of Medicine.Techniques: Thyroid Exam.National Institute of Diabetes and Digestive and Kidney Diseases.Thyroid Tests.Radiological Society of North America.Thyroid Scan and Uptake.Joffe RT.How should lithium-induced thyroid dysfunction be managed in patients with bipolar disorder?J Psychiatry Neurosci.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Lazarus JH.Lithium and thyroid.Best Pract Res Clin Endocrinol Metab. 2009;23(6):723-33. doi:10.1016/j.beem.2009.06.002Cleveland Clinic.Goiter: Management and Treatment.Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-yKibirige D, Luzinda K, Ssekitoleko R.Spectrum of lithium induced thyroid abnormalities: a current perspective.Thyroid Res. 2013;6(1):3. Published 2013 Feb 7. doi:10.1186/1756-6614-6-3University of Washington Department of Medicine.Techniques: Thyroid Exam.National Institute of Diabetes and Digestive and Kidney Diseases.Thyroid Tests.Radiological Society of North America.Thyroid Scan and Uptake.Joffe RT.How should lithium-induced thyroid dysfunction be managed in patients with bipolar disorder?J Psychiatry Neurosci.
Lazarus JH.Lithium and thyroid.Best Pract Res Clin Endocrinol Metab. 2009;23(6):723-33. doi:10.1016/j.beem.2009.06.002
Cleveland Clinic.Goiter: Management and Treatment.
Gitlin M.Lithium side effects and toxicity: prevalence and management strategies.Int J Bipolar Disord. 2016;4(1):27. doi:10.1186/s40345-016-0068-y
Kibirige D, Luzinda K, Ssekitoleko R.Spectrum of lithium induced thyroid abnormalities: a current perspective.Thyroid Res. 2013;6(1):3. Published 2013 Feb 7. doi:10.1186/1756-6614-6-3
University of Washington Department of Medicine.Techniques: Thyroid Exam.
National Institute of Diabetes and Digestive and Kidney Diseases.Thyroid Tests.
Radiological Society of North America.Thyroid Scan and Uptake.
Joffe RT.How should lithium-induced thyroid dysfunction be managed in patients with bipolar disorder?J Psychiatry Neurosci.
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