Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2024; 12(20): 4357-4364
Published online Jul 16, 2024. doi: 10.12998/wjcc.v12.i20.4357
Lithium carbonate-induced giant goiter and subclinical hyperthyroidism in a patient with schizophrenia: A case report and review of literature
Xing-Ming Chen, Zhi-Li Jiang, Xiang Wu, Xu-Guang Li
Xing-Ming Chen, Department of Psychiatry, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, Guangdong Province, China
Zhi-Li Jiang, Xiang Wu, Xu-Guang Li, Department of General Surgery, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, Guangdong Province, China
Xu-Guang Li, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province, The Ministry of Education of China, Guangzhou Medical University, Guangzhou 511436, Guangdong Province, China
Co-first authors: Xing-Ming Chen and Zhi-Li Jiang.
Author contributions: Chen XM contributed to manuscript writing, editing, and literature collection; Jiang ZL reviewed the manuscript, designed the figures and tables, and performed data collection; Wu X and Li XG reviewed the manuscript, contributed to conceptualization and supervision, and provided funding.
Supported by the Guangzhou Research-oriented Hospital.
Informed consent statement: The patient provided written informed consent to participate in this case report. Written informed consent was also obtained from the patient for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xu-Guang Li, Doctor, MD, PhD, Chief Doctor, Professor, Department of General Surgery, The Affiliated Brain Hospital of Guangzhou Medical University, No. 36 Mingxin Road, Liwan District, Guangzhou 510370, Guangdong Province, China. lxg_gynk@163.com
Received: March 9, 2024
Revised: May 1, 2024
Accepted: May 27, 2024
Published online: July 16, 2024
Processing time: 112 Days and 13.3 Hours
Abstract
BACKGROUND

Lithium carbonate is used to manage various mood disorders, but it can cause thyroid abnormalities, including goiter, hypothyroidism, and hyperthyroidism. In rare cases, it can lead to giant goiter and subclinical hyperthyroidism, which may require surgical intervention in severe cases.

CASE SUMMARY

This case represents a rare development of giant goiter and subclinical hyperthyroidism in a schizophrenia patient who was subjected to prolonged lithium carbonate treatment. The enlarged thyroid gland caused pressure on the airway and recurrent laryngeal nerve, which led to respiratory distress, hoarseness, and dysphagia. The immediate danger of suffocation required urgent surgical intervention. In this report, we describe the case of a 41-year-old Chinese woman. This sheds light on the etiology and challenges associated with managing a giant goiter. The patient underwent a subtotal thyroidectomy to relieve airway compression and facilitate airway expansion. Prior to the procedure, the patient was given iodine to prepare. Concurrently, changes were made to the psychiatric medication regimen. Following surgery, the patient's respiratory function and vocal cord functionality improved significantly, and her mental state remained stable.

CONCLUSION

It is essential to monitor thyroid function, test thyroid antibody levels, and perform thyroid ultrasounds consistently in all patients undergoing long-term lithium carbonate treatment. This vigilance helps prevent severe and potentially life-threatening thyroid enlargement.

Keywords: Lithium carbonate, Giant goiter, Subclinical hyperthyroidism, Schizophrenia, Subtotal thyroidectomy, Case report

Core Tip: This case uniquely highlighted an innovative approach to managing a rare occurrence of giant goiter and subclinical hyperthyroidism in a schizophrenia patient undergoing prolonged lithium carbonate treatment. Urgent surgical intervention was implemented to address potential airway compression and recurrent laryngeal nerve involvement, resulting in significant improvements in respiratory and vocal cord function and stable mental health following surgery.