Abstract
Lithium carbonate is a drug for manic depression. We experienced an operated patient with hyperparathyroidism which might be induced by lithium.
A 54-year-old woman had been received lithium carbonate 600-1200 mg daily for manic-depressive psychosis since 1980. In 1989, the patient was pointed out hypercalcemia, and she was referred to the hospital because of suspected hyperparathyroidism caused by lithium carbonate in January 1990. Serum calcium and iPTH levels were as high as 13.1 ml/dl and 12.4% pg/ml, respectively. Parathyroidectomy of the right lower gland was carried out under the diagnosis of hyperparathyroidism. The tumor was 419 mg in weight and was adenoma histologically. There has been no recurrence for one year and 11 months after the operation. It can be thought that two actions of lithium, namely, parathyroid hormone-releasing action from the parathyroid tissues and growth promoting action, might cause hyperparathyroidism. If lithium induces hyperparathyroidism in the normal gland, one could make a possible candidate for subtotal thyroidectomuy (hyperplasia). If lithium promotes hyperparathyroidism, the appropriate treatment would be excision of the adenoma. For rational selection of operative procedure, the improtance of clarification of etiology for the disease is emphansized.
