TG and hyperthyroidism: Carmaciu et al [3] further delineates five mechanisms in which lithium is thought to mediate thyrotoxicosis in some patients that have been on maintenance treatment: (1) lithium triggered autoimmune process with resultant anti-thyroid antibodies; (2) abnormal iodine kinetics, that is, overflow of thyroid hormone after expansion of the intrathyroid iodine pool; (3) Jod-Basedow-like phenomenon; (4) direct toxicity to thyroid follicules, resulting in release of thyroglobulin; and (5) coincidental Graves' disease and hyperthyroidism.