A cass of a female Manic Depressive Illness patient with goitrous hypothyroidism is prsented. After ten and half months of lithium maintenance therapy starting during her first psychiatric admission, she was admitted again due to acute recurrent manic episode. On admission, she complained easy fatigability and cold intolerance, and thyroid gland was palpable and enlarged in moderate degree. Thyroid function test revealed markedly increased TSH and moderately decreased thyroxine levels. TRH stimulation test showed an exaggerated response. Needle biopsy specimen revealed chronic lymphocytic and immune complex thyroid it is. However, antithyroglobulin and antimicrosom al antibodies were negative. In pretreatment thyroid evaluation on her first admission, neither goiter nor thyroid function abnorm ality was - detectable and no signs of underlying thyroid disease or hereditary predisposition to hypothyroidism were present. Within three weeks o f discontinuation of lithium, goiter was no more palpable and within five weeks, thyroid function test returned to normal range. The possibility that patients with underlying thyroiditis may be particularly susceptible to a rapid onset of lithium-induced hypothyroidism is discussed.
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