title: Using ultrasonography to determine thyroid size and prevalence of goiter in lithium-treated patients with affective disorders.
abstract: BACKGROUND
  To determine thyroid gland volume and the prevalence of goiter in patients receiving long-term lithium treatment for affective disorders.
  
  
  METHODS
  In this cross-sectional study, we performed ultrasonographic examinations in 96 patients on long-term lithium treatment, including those with bipolar, major depressive, and schizoaffective disease. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months were recruited consecutively from the Berlin Lithium Clinic. Ultrasonographic examinations were also performed in 96 gender- and age-matched control subjects. Patients and controls were 18 years of age or older and were residents of Berlin, Germany and surrounding areas.
  
  
  RESULTS
  Total thyroid volume was significantly greater in the lithium-treated group than among controls (23.7 ml vs. 13.6 ml). Ultrasonography detected that significantly more lithium-treated subjects had goiter than did control subjects (N=53 vs. N=19). Clinical inspection and palpation only detected goiter in 24 of the lithium-treated patients and in 12 control subjects. In a patient subgroup taking levothyroxine, the prevalence of goiter was still 37%. Patients who were not taking levothyroxine had significantly higher TSH basal levels than normal controls (2.1 mU/L vs. 1.3 mU/L).
  
  
  CONCLUSIONS
  Cross-sectional study; no control for other factors related to thyroid enlargement and goiter such as dietary issues, smoking, or iodine intake; affectively ill subjects were treated with additional psychotropic medications.
  
  
  CONCLUSIONS
  Thyroid enlargement was found in a significant number of lithium-treated patients. Ultrasonography proved superior to palpatory inspection in detecting goiter. Regular use of ultrasonography for early detection of thyroid enlargement in patients on long-term lithium treatment is therefore recommended.
authors.affiliation: Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. michael.bauer@uniklinikum-dresden.de
authors.forename: Michael
authors.initials: M
authors.lastname: Bauer
authors.forename: Holger
authors.initials: H
authors.lastname: Blumentritt
authors.forename: Reinhard
authors.initials: R
authors.lastname: Finke
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.forename: Mazda
authors.initials: M
authors.lastname: Adli
authors.forename: Christopher
authors.initials: C
authors.lastname: Baethge
authors.forename: Tom
authors.initials: T
authors.lastname: Bschor
authors.forename: Bruno
authors.initials: B
authors.lastname: Müller-Oerlinghausen
authors.forename: Anne
authors.initials: A
authors.lastname: Berghöfer
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006042:Goiter / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000453:epidemiology; D013961:Thyroid Gland / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000187:drug effects; D014463:Ultrasonography
chemical_list: D000928:Antidepressive Agents; D016651:Lithium Carbonate