Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Ibrahim, Yasin; Mohamed, Salah Edin; Deniwar, Ahmed; Al‐Qurayshi, Zaid; Kandil, Emad

doi:10.1159/000431230

Cited by 9 publications

(7 citation statements)

References 36 publications

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“…Several studies stated that patients with carcinoma were older than those with a benign disease (28,29,31). Similary, we reported that patients with >45 age were statistically significant have a malignant lesion than those with <45 age, which is also independent risk factor for malignancy by 4.2 times by regression analys.…”

Section: Discussionsupporting

confidence: 83%

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Öz

Doğan

Emek

et al. 2018

International Surgery

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The objective of the current study was to determine the risk of malignancy in patients with thyroid nodules with cytology of indeterminate follicular and indeterminate Hürthle cell neoplasm (HN). The cytologic diagnosis of follicular neoplasm (FN) or HN remains a diagnostic challenge. Often, surgery is recommended for such lesions. A retrospective analysis was performed on 80 patients who underwent thyroid surgery following a diagnosis of indeterminate FN and indeterminate HN in thyroid fine-needle aspiration biopsy. Sex; age; family history of thyroid cancer and radiation exposure; coexisting thyroid conditions, such as solitary nodule; multinodularity; cytologic diagnosis; sonographic features; type of surgical treatment; and histopathologic results were recorded. Of the 80 patients, 52 (65%) had FN on fine-needle aspiration biopsy cytology and 28 (35%) had HN. A total of 23 patients (28.7%) had primary thyroid cancers on surgical pathology, and 57 (71.3%) had benign diagnoses. Univariate analysis showed no differences between the benign and malignant groups by sex, nodule size, family history of thyroid cancer, history of radiation exposure, presence of solitary nodule or multinodularity in the nodular features. In multivariate binary logistic regression analysis, the factors that were statistically significant predictors of malignancy were microcalcification [odds ratio (OR), 10.9; 95% confidence interval (CI), 2.18–54.7; P = 0.004], being older than 45 years (OR, 4.2; 95% CI, 1.25–14.63; P = 0.02]. The independent predictors of malignancy in FN and HN are micorcalcification and being older than 45 years, the use of which may predict the risk of thyroid cancer.

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Section: Discussionsupporting

confidence: 83%

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Öz

Doğan

Emek

et al. 2018

International Surgery

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“…Most studies have shown that lithium-induced hyperparathyroidism is associated with the presence of a solitary parathyroid adenoma (92–96). However, lithium-induced polyglandular hyperplasia has also been described (95–97).…”

Section: Lithium and Parathyroid Tumorsmentioning

confidence: 99%

The Role of Lithium in Management of Endocrine Tumors—A Comprehensive Review

2019

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Background: Epidemiological data reveal that treatment with lithium, a mood stabilizer, is associated with decreased incidence and mortality of certain cancer types, such as melanoma. Therefore, repositioning of lithium as an anticancer agent has emerged as a promising strategy in oncology. Since lithium affects the physiology of several endocrine tissues, the goal of this study was to analyze the role of lithium in the pathogenesis and treatment of tumors of the endocrine system.Methods: The databases of PubMed, EMBASE, MEDLINE, were searched from January 1970 through February 2019 for articles including the keywords “lithium and”—“thyroid cancer,” “thyroid nodule,” “parathyroid adenoma,” “parathyroid carcinoma,” “pituitary adenoma,” “pituitary neuroendocrine tumor,” “neuroendocrine tumor,” “carcinoid,” “adrenal adenoma,” “adrenal carcinoma,” “pheochromocytoma/paraganglioma.” Preclinical in vitro and in vivo studies as well as case series, retrospective cohort studies and prospective trials were selected for the analysis.Results: Treatment with lithium has been associated with a higher prevalence of thyroid enlargement, hypothyroidism and increased calcium levels due to parathyroid adenoma or hyperplasia, as one of the mechanisms of its action is to stimulate proliferation of normal follicular thyroid and parathyroid cells via activation of the Wnt signaling pathway. Supratherapeutic concentrations of lithium decrease the activity of glycogen synthase kinase-3β (GSK-3β), leading to cell cycle arrest in several in vitro cancer models including medullary thyroid cancer (TC), pheochromocytoma/paraganglioma and carcinoid. Growth inhibitory effects of lithium in vivo have been documented in medullary TC xenograft mouse models. Clinically, lithium has been used as an adjuvant agent to therapy with radioactive iodine (RAI), as it increases the residence time of RAI in TC.Conclusion: Patients chronically treated with lithium need to be screened for hypothyroidism, goiter, and hyperparathyroidism, as the prevalence of these endocrine abnormalities is higher in lithium-treated patients than in the general population. The growth inhibitory effects of lithium in medullary TC, pheochromocytoma/paraganglioma and carcinoid were achieved with supratherapeutic concentrations of lithium thus limiting its translational perspective. Currently available clinical data on the efficacy of lithium in the therapy of endocrine tumors in human is limited and associated with conflicting results.

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“…If a patient's medical team has recommended surgery, imaging assistance for surgical planning may be equivocal. Given the high rate of multiglandular parathyroid disease (MGD) (20–55%) [8, 9, 10, 11, 12, 13], it is important to note that the normally high sensitivity of sestamibi imaging in detecting parathyroid adenomas goes down with concomitant thyroid abnormalities and in MGD patients [17, 23, 24]. According to Nichols et al [25, 26], sestamibi imaging sensitivity is 61% for MGD versus 97% for single-gland parathyroid disease (SGD).…”

Section: Review Of the Literature: Medical Versus Surgical Managementmentioning

confidence: 99%

“…Care needs to be employed in utilizing the surgical approach, due to the heterogeneous types of lesions noted in LAH. Estimates for prevalence of MGD range from 20% up to 55% in different series [9, 10]. It has also been noted in studies that patients with SGD tend to be easier to control and to remain normocalcemic after parathyroidectomy.…”

Section: Review Of the Literature: Medical Versus Surgical Managementmentioning

confidence: 99%

“…One of the most complex complications of Li therapy is parathyroid dysfunction that occurs due to adenoma formation or hyperplasia of the parathyroid gland(s) under the trophic influence of CaSR stimulation by Li [8]. Li-associated hyperparathyroidism (LAH) presents with single adenomas in 45–80% of cases and with generalized hyperplasia in the other 20–55% of cases, with varying percentages in different series [8, 9, 10, 11, 12, 13]. When conservative management fails or is not possible, there is a 60–80% cure rate with surgery [11, 13, 14].…”

Section: Introductionmentioning

confidence: 99%

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Three Patients with Lithium-Associated Hyperparathyroidism: Literature Review Regarding Medical and Surgical Management

Hanna¹,

Hasnain²,

Sangalang³

et al. 2019

Case Rep Nephrol Dial

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Lithium (Li) carbonate has been established as a mood stabilizer and an efficacious treatment for bipolar disorder since its discovery by Dr. John Cade in 1948. Li interacts significantly with organ systems and endocrine pathways. One of the most challenging side effects of Li to manage is its effect on the parathyroid glands. Dysregulation of parathyroid signaling due to Li results in hypercalcemia due to increased vitamin D3 generation, increased calcium absorption from the gut, and bone resorption, occasionally resulting in concomitant hypercalciuria. However, hypercalciuria is not a definitive feature for hyperparathyroidism, and normal calcium excretion might be seen in these patients. Hypercalcemia may also result from volume contraction and decreased renal clearance, which are commonly seen in these patients. Anatomically the parathyroid abnormalities can present as single or multiglandular disease. We report 3 cases where the patients developed multiple side effects of Li therapy as well as hypercalcemia due to hyperparathyroidism. The literature is reviewed with regard to medical and surgical management of Li-associated hyperparathyroidism in the context of these 3 presented cases.

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Lithium-Associated Hyperparathyroidism: A Pooled Analysis

Cited by 9 publications

References 36 publications

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

Predictive Factors of Malignancy in Cytology of Indeterminate Follicular and Hürthle Cell Neoplasms of the Thyroid Gland

The Role of Lithium in Management of Endocrine Tumors—A Comprehensive Review

Three Patients with Lithium-Associated Hyperparathyroidism: Literature Review Regarding Medical and Surgical Management

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