SYNOPSISSeventy-three patients who had been continuously receiving lithium carbonate for 6 months or more had their thyroid function evaluated clinically and biochemically. Goitre was found in 37 %, exophthalmos in 23 %, positive thyroid auto-antibodies in 24 % and abnormal TRH tests in 49 %. It would appear that thyroid failure due to lithium is usually dependent on antibody mediated damage. It is unlikely that lithium has a direct effect on the hypothalamic–pituitary axis.

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Thyroid function was assessed in a prospective survey of 13 manicdepressive patients before and after 3 months on lithium carbonate and in a further 12 patients who had received lithium for 20 months. There was a significant increase in thyroid size as measured by quantitative scintiscanning in 8 patients in the first group. One male in the second group had a goitre. There was a rise in plasma TSH in the first group and a significant fall in saliva to plasma iodide. It is suggested that pathogenesis of lithium induced goitre is related to a disturbance in the iodide concentrating mechanism. Thyroid status should be evaluated in patients who are suitable for lithium therapy.

and conclusions Plasma growth hormone (GH), prolactin, and corticosteroid responses to insulin-induced hypoglycaemia were studied in 24 men with progressive alcoholism who had been abstinent for two to seven days. Ten normal healthy subjects (five men, five women) served as controls for comparing GH and prolactin responses, while cortisol responses were studied in a further six male controls. Blood samples were taken at intervals after an injection of soluble insulin (01 U/kg body weight). All patients developed adequate hypoglycaemia (blood glucose <2 2 mmol/l (<39-6 mg/100 ml)) and nine had impaired GH responses (peak concentration < 10 mU/l). Prolactin concentrations fell or remained unchanged in nine patients, eight of whom also had impaired GH responses. In seven patients corticosteroid concentra