Effect of Lithium on the Thyroid Gland

Lazarus, John; Collard, Keith J.

doi:10.1007/978-1-4899-2016-4_5

Cited by 13 publications

(8 citation statements)

References 110 publications

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“…In cross-sectional stud¬ ies, there are numerous reports (see ref. 6) showing that lithium therapy prescribed to psychiatric patients results in an exaggerated TSH response to TRH in at least 50% of patients rising to 100% in others (Fig. 1).…”

Section: Effect On the Hypothalamic Pituitary Axismentioning

confidence: 97%

“…Some groups, how¬ ever, have found no goiter, while others have found inci¬ dence rates of 30%, 37%, and 60%, respectively (see refs. [4][5][6]. If imaging techniques such as scintiscanning or ul¬ trasound were used, significant thyroid enlargement was noted after 3 months of lithium treatment when thyroid volume was compared with pretreatment values (40) in normal female volunteers after 28 days of lithium therapy, but not in males (41).…”

Section: Clinical Effects Of Lithium On Thyroid Functionmentioning

confidence: 99%

“…others. Since then, a large number of clinical and experi¬ mental studies on the effect of lithium on thyroid physiol-THE main use of lithium in therapeutics is in the treatogy have been performed and reviewed (4)(5)(6). This article ment and prophylaxis of manic depressive psychosis, briefly reviews lithium effect on cellular metabolism prior In 1949, J.F.J.…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Lithium Therapy on Thyroid and Thyrotropin-Releasing Hormone

Lazarus¹

1998

Thyroid

171

102

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Lithium is used in the prophylaxis of bipolar depressive disorder in augmentation treatment of depression and in the therapy of some cases of unipolar depression. Lithium affects cell function via its inhibitory action on adenosine triphosphatase (ATPase) activity, cyclic adenosine monophosphate (cAMP), and intracellular enzymes. The inhibitory effect of lithium on inositol phospholipid metabolism affects signal transduction and may account for part of the action of the cation in manic depression. Lithium also alters the in vitro response of cultured cells to thyrotropin-releasing hormone (TRH) and can stimulate DNA synthesis. Lithium is concentrated by the thyroid and inhibits thyroidal iodine uptake. It also inhibits iodotyrosine coupling, alters thyroglobulin structure, and inhibits thyroid hormone secretion. The latter effect is critical to the development of hypothyroidism and goiter. Effects on brain deiodinase enzymes and alterations in thyroid hormone receptor concentration in the hypothalamus are under investigation in relation to the therapeutic effect of lithium. The ion affects many aspects of cellular and humoral immunity in vitro and in vivo. This accounts for a rise in antithyroid antibody titer in patients having these antibodies before lithium administration whereas there is no induction of thyroid antibody synthesis de novo. Goiter, due to increased thyrotropin (TSH) after inhibition of thyroid hormone release, occurs at various reported incidence rates from 0%-60% and is smooth and nontender. Subclinical and clinical hypothyroidism due to lithium is usually associated with circulating anti-thyroid peroxidase (TPO) antibodies but may occur in their absence. Iodine exposure, dietary goitrogens, and immunogenetic background may all contribute to the occurrence of goiter and hypothyroidism during long-term lithium therapy. It is currently unclear whether the reported association of lithium therapy and hyperthyroidism are causal, although there is suggestive epidemiological evidence. Finally, lithium therapy is associated with exaggerated response of both TSH and prolactin to TRH in 50%-100% of patients, although basal levels are not usually high. It is probable that the hypothalamic pituitary axis adjusts to a new setting in patients receiving lithium.

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Section: Effect On the Hypothalamic Pituitary Axismentioning

confidence: 97%

Section: Clinical Effects Of Lithium On Thyroid Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effects of Lithium Therapy on Thyroid and Thyrotropin-Releasing Hormone

Lazarus¹

1998

Thyroid

171

102

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“…Several mechanisms have been proposed to explain the development of increase thyroid volume like lithium is concentrated by the thyroid and inhibits thyroidal iodine uptake. [ 24 ]…”

Section: Discussionmentioning

confidence: 99%

Thyroid hormone levels and ultrasonographic changes in the thyroid gland of patients on long-term Lithium treatment for affective disorders: A controlled study

et al. 2020

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Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Methods: This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender ( P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six ( n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

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“…[ 7 ] Several mechanisms have been hypothesized to explain the development of increase thyroid volume, like Lithium is concentrated by the thyroid and inhibits thyroidal iodine uptake. [ 31 ]…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographically Measured Change in Thyroid Status in Lithium Treated Adult Patients with Mood Disorder

Alam

Sinha

Nizamie

2016

Indian Journal of Psychological Medicine

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Background:Lithium, which is frequently used in the treatment of mood disorder, can lead to various types of thyroid dysfunctions. Although clinical examination and biochemical assessment are fundamental to any thyroid work-up of lithium-treated patients, assessment findings vary widely depending on the investigator. Ultrasonographic measurement of thyroid volume has, therefore, been performed in lithium treatment populations and found to be a sensitive tool.Aim:We aimed to determine and compare thyroid gland volume using Ultrasonography and laboratory parameters, (thyroid-stimulating hormone [TSH], T3, and T4) in long-term lithium and other mood stabilizers treated patients with mood disorder.Materials and Methods:In this cross-sectional study, we performed ultrasonography examinations and thyroid function test of 30 patients on lithium treatment and 30 patients on other mood stabilizers.Results:The ultrasonographically measured thyroid volume was significantly increased in patients receiving lithium therapy as compared to the patients receiving other mood stabilizers. The total triiodothyronine (T3) was significantly increased with trends toward increased total thyroxine (T4) and decreased TSH in patients receiving lithium therapy as compared to the patients receiving other mood stabilizers.Conclusion:These results highlight the need of including ultrasonographic measurement of thyroid volume as a part of standard thyroid work-up before initiating lithium prophylaxis and during follow-up. Additional studies on the incidence and mechanism of lithium associated hyperthyroidism are needed.

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Effect of Lithium on the Thyroid Gland

Cited by 13 publications

References 110 publications

The Effects of Lithium Therapy on Thyroid and Thyrotropin-Releasing Hormone

The Effects of Lithium Therapy on Thyroid and Thyrotropin-Releasing Hormone

Thyroid hormone levels and ultrasonographic changes in the thyroid gland of patients on long-term Lithium treatment for affective disorders: A controlled study

Ultrasonographically Measured Change in Thyroid Status in Lithium Treated Adult Patients with Mood Disorder

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