lithium inhibits the secretion of T4 and T3 by poorly understood mechanisms
lithium is associated with thyroiditis, goitre, hypothyroidism and possibly hyperthyroidism
goitre - the incidence of goitre in patients on treatment with lithium approaches 50%; generally it presents as a smooth enlargement of the thyroid gland and requires no further intervention
hypothyroidism - occurs in 20-30% of patients on lithium treatment; responds to treatment with thyroxine; generally not necessary to stop lithium treatment
prior to commencing treatment with lithium patients should have a neck examination and thyroid function tests; thyroid function should then be checked every 6-12 months whilst on lithium treatment
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