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Lithium Therapy-Associated Thyroid Alterations Mimicking Thyroid Malignancy: A Diagnostic Pitfall.

Irene Y Chen1, Adel K El-Naggar2

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International Journal of Surgical Pathology
|December 1, 2025
PubMed
Summary
This summary is machine-generated.

Lithium therapy can cause thyroiditis that mimics cancer, leading to misdiagnosis and unnecessary surgery. Recognizing lithium

Keywords:
histologic alterationlithiumthyroidthyroid carcinomathyroiditis

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Area of Science:

  • Endocrinology
  • Oncology
  • Pathology

Background:

  • Lithium is a crucial mood stabilizer for bipolar disorder, but its association with thyroid dysfunction, particularly hypothyroidism, is known.
  • Lithium-induced thyroiditis, though rare, can present with significant histomorphologic changes that may be mistaken for malignancy.
  • Accurate diagnosis of thyroid nodules is critical to avoid overtreatment, especially in patients with a history of lithium use.

Purpose of the Study:

  • To report a case of a thyroid nodule initially misdiagnosed as high-grade thyroid carcinoma due to severe histomorphologic changes.
  • To reclassify the thyroid nodule as an iatrogenic effect of long-term lithium therapy upon expert review.
  • To highlight the importance of considering lithium therapy in the differential diagnosis of thyroid lesions mimicking malignancy.

Main Methods:

  • Review of histopathologic findings of a thyroid nodule from an outside institution.
  • Analysis of clinical history, including long-term lithium therapy.
  • Comparison of observed histologic features with the 2022 WHO classification criteria for thyroid carcinoma.

Main Results:

  • The thyroid nodule, initially diagnosed as high-grade carcinoma, was reclassified as lithium-associated thyroiditis.
  • Histologic features such as fibrosis, inflammation, and hyperplasia mimicked malignancy but lacked key indicators like mitotic activity.
  • The patient underwent unnecessary completion thyroidectomy due to misinterpretation of the initial biopsy and lobectomy findings.

Conclusions:

  • Lithium-induced thyroiditis can present with features that closely resemble thyroid carcinoma, necessitating careful clinicopathologic correlation.
  • A thorough patient history, especially regarding lithium use, is paramount in diagnosing thyroid lesions and preventing overtreatment.
  • This case underscores the need for awareness of iatrogenic thyroid changes and the evolving diagnostic criteria for thyroid tumors.