On the Prevalence, Diagnosis and Management of Lithium-Induced Hypothyroidism in Psychiatric Patients

Lindstedt, Göran; Nilsson, Lars‐Åke; Wålinder, Jan; Skott, Annika; Öhman, Rolf

doi:10.1192/bjp.130.5.452

Cited by 79 publications

(22 citation statements)

References 11 publications

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“…Cross-sectional studies of lithium-induced goitre reveal a prevalence of 0 to 60% [51]; prevalence estimates are much higher (30–59%) when more sensitive ultrasonographic scans are used to detect increases in thyroid volumes [32, 87, 90]. Several studies of patients on lithium have found an elevated rate of anti-thyroid antibodies, ranging from about 8 to 49% in such patients; these rates were significantly higher than those among control patients or the general population [84, 89, 91–100]. An almost equal number of studies have failed to find an association between elevated antibody titres and exposure to lithium [32, 53, 73, 74, 101–104].…”

Section: Lithium and Hpt Axis Dysfunctionmentioning

confidence: 99%

Thyroid Functions and Bipolar Affective Disorder

Chakrabarti

2011

Journal of Thyroid Research

110

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Accumulating evidence suggests that hypothalamo-pituitary-thyroid (HPT) axis dysfunction is relevant to the pathophysiology and clinical course of bipolar affective disorder. Hypothyroidism, either overt or more commonly subclinical, appears to the commonest abnormality found in bipolar disorder. The prevalence of thyroid dysfunction is also likely to be greater among patients with rapid cycling and other refractory forms of the disorder. Lithium-treatment has potent antithyroid effects and can induce hypothyroidism or exacerbate a preexisting hypothyroid state. Even minor perturbations of the HPT axis may affect the outcome of bipolar disorder, necessitating careful monitoring of thyroid functions of patients on treatment. Supplementation with high dose thyroxine can be considered in some patients with treatment-refractory bipolar disorder. Neurotransmitter, neuroimaging, and genetic studies have begun to provide clues, which could lead to an improved understanding of the thyroid-bipolar disorder connection, and more optimal ways of managing this potentially disabling condition.

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Section: Lithium and Hpt Axis Dysfunctionmentioning

confidence: 99%

Thyroid Functions and Bipolar Affective Disorder

Chakrabarti

2011

Journal of Thyroid Research

110

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“…Psychiatric patients on lithium (Li) therapy frequently develop goiter and/or hypothyroidism [1], These effects are commonly ascribed to the antithyroid activity of Li [2], but the possibility that this drug might trigger thyroid autoimmunity has also been suggested [3][4][5], However, the data supporting the latter hypothesis are scanty and contradictory; the prevalence of circulating antithyroid autoantibodies in patients on long-term Li therapy ranges from 14 to 50% in different investigations [6][7][8][9] and no conclusive data may be derived from the few longitudinal studies presently available [9][10][11][12], Differences in individ ual sensibility related to genetic heterogeneity and/or to underlying subclinical thyroid disease might explain the above discrepancies.…”

Section: Introductionmentioning

confidence: 99%

Value of Thyroid Echography in the Long-Term Follow-Up of Lithium-Treated Patients

Loviselli¹,

Bocchetta

Mossa³

et al. 1997

Neuropsychobiology

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Psychiatric patients on long-term lithium (Li) therapy frequently develop goiter and/or hypothyroidism. It has also been suggested that Li may trigger/ exacerbate thyroid autoimmunity. Previous studies provided evidence that underlying thyroid diseases represent important predisposing factors for the development of Li-induced thyroid dysfunction. The aim of the present paper was to assess the value of thyroid ultrasound – a simple and reliable tool to detect subtle thyroid abnormalities – in the longitudinal evaluation of 23 Li-treated psychiatric patients without evidence of biochemical thyroid abnormalities before therapy. For this purpose, thyroid ultrasound was associated with a clinical and laboratory (serum thyroxine, serum triiodothyronine, serum TSH, antithyroglobulin (AbTg), antithyroid microsomal (AbM) and antithyroid peroxidase autoantibodies) evaluation prior to and at 6- to 12-month intervals during Li treatment. On the basis of thyroid ultrasound before Li, patients were subdivided into two groups: group A (n = 15, 7 males, 8 females) with a normal echography and group B (n = 8, 5 males, 3 females) with mild ultrasound abnormalities. In group A the development of a small diffuse goiter was confirmed by physical examination during Li therapy; 2 patients displayed a transient increase of serum TSH concentration and none developed detectable serum antithyroid autoantibodies. Beside the small volumetric increase, no other ultrasound abnormalities were observed during the entire follow-up. In all group B patients a mild diffuse goiter was clinically detected before and on Li administration and no significant volumetric changes were observed during follow-up. Two patients developed high titers of AbM and AbTg 12 and 18 months after the beginning of Li, respectively; in 1 a persistent increase of serum TSH concentration was also observed. Thyroid echography before Li displayed different degrees of scattered or diffuse hypo-echogenicity and a further decrease in echogenicity was detected during Li therapy in 2 patients. In conclusion, we provided further evidence that long-term Li administration is not associated with de novo appearance of thyroid autoimmune phenomena in humans, but rather with an exacerbation of underlying thyroid autoimmunity. In addition to thyroid autoantibody and TSH measurements, thyroid echography appears to be a sensitive tool in the identification of patients at risk of developing autoimmune hypothyroidism during long-term Li therapy.

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“…An increased prevalence of hypothyroid ism (15-25%, depending on the mode of classification) [60], in some cases accompa nied by a compensatory goiter, is well estab lished among long-term lithium patients [67], Biochemical changes, e.g. increased se rum thyrotropin (TSH), as well as goiter with or without biochemical hypothyroidism, re spond to adequate substitution treatment with thyroid hormones, but an internist should be consulted before institution of such treatment [59,66].…”

Section: Lithium In Endocrinologymentioning

confidence: 99%

Use of Lithium in the Medically Ill

Amdisen

Hildebrandt²

1988

Psychother Psychosom

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For more than one hundred years (about 1845–1950), lithium salts were used to treat disorders belonging to ‘the uric acid diathesis’ (‘gouty diseases’). It was introduced into modern psychiatry as an antimanic agent, but its current use is mostly as a prophylactic in bipolar and unipolar manic-depressive illness. In the present context, however, this psychiatric use may, in some instances, create special nonpsychiatric problems such as lithium poisoning, renal diabetes insipidus, and weight gain. Moreover, most lithium patients are outpatients, so that medical complaints caused by the treatment are in most cases presented to the general practitioner, the neurologist, the nephrologist, the cardiologist, etc. rather than to the psychiatrist. Lithium treatment is frequently accompanied by both short-term and long-term side effects and some of these, e.g. the thyroid-depressing effect and leukocytosis, may be medically exploited. Like manic-depressive illness, some medical disorders such as certain types of headache have a periodic course and appear to respond favorably to long-term lithium treatment. Cooperation between researchers in biological psychiatry and nephrologists has resulted in the suggestion that lithium may be used as an indicator of proximal sodium and water reabsorption, which has later led to the suggestion that the renal lithium clearance is an indicator of proximal renal tubular function.

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On the Prevalence, Diagnosis and Management of Lithium-Induced Hypothyroidism in Psychiatric Patients

Cited by 79 publications

References 11 publications

Thyroid Functions and Bipolar Affective Disorder

Thyroid Functions and Bipolar Affective Disorder

Value of Thyroid Echography in the Long-Term Follow-Up of Lithium-Treated Patients

Use of Lithium in the Medically Ill

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