Subclinical hypothyroidism in recurrent mania

Terao, Takeshi

doi:10.1016/0006-3223(93)90034-b

Cited by 3 publications

(2 citation statements)

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“…As many as 60% to 92% of patients with rapid cycling, but only one third as many without rapid cycling, have been found to have hypothyroidism that is not severe enough to cause medical morbidity, but could contribute to mood instability as a result of unclear actions of thyroid and thyrotrophic hormones as neuromodulators [29,30]. Lithium itself may cause rapid cycling by inducing hypothyroidism [31]. A comparison of 31 patients with rapid cycling with 36 patients without rapid cycling did not find significant differences in T4 or T3 levels, or a significant correlation between T4 levels and number of affective episodes [32]; however, because thyroid-stimulating hormone (TSH) was not measured and thyroid-releasing hormone (TRH) stimulation tests, which can identify subclinical forms of hypothyroidism, were not obtained, it cannot be said that more subtle forms of thyroid dysfunction were not present.…”

Section: Etiologic Issues Relevant To Treatment Planningmentioning

confidence: 99%

Rapid cycling bipolar disease: New concepts and treatments

Dubovsky

2001

Curr Psychiatry Rep

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Section: Etiologic Issues Relevant To Treatment Planningmentioning

confidence: 99%

Rapid cycling bipolar disease: New concepts and treatments

Dubovsky

2001

Curr Psychiatry Rep

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“…29 The patient in case 4 suffered from hypothyroidism; lithium might have prevented the release of thyroxine (T4) and triiodothyronine (T3), thereby exacerbating the hypothyroid state (as outlined by the letter to the editor by Terao). 30 A hypothyroid patient might have experienced symptoms ranging from mild attentional impairment to severe delirium -symptoms mirroring those of a lithium-induced confusional state.…”

Section: Discussionmentioning

confidence: 99%

Lithium carbonate-induced confusional state in patients with bipolar disorder: identification of case reports and review of the evidence

Lyons,

Gossell-Williams

2024

Caribb Med J

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Objective: Lithium carbonate is a mood stabilizer used in the treatment of bipolar disorder. However, its narrow therapeutic index (normal = 0.6-1.2 mmol/L) predisposes patients to toxic effects. This study aimed to identify case reports and review the evidence on the frequency, mechanism, risk factors and guidelines associated with a lithium-induced confusional state in patients with bipolar disorder. Methods: All Databases from the National Center for Biotechnology Information (NCBI) were used to search for lithium AND “confusional state” AND “case report” published in English between 2015 and 2020. This search engine was also used to search for lithium AND “confusional state” AND frequency OR mechanism OR “risk factor” OR guideline published in English. Results: Case reports showed (1) all patients were treated with lithium for bipolar disorder and hospitalized for a confusional state, (2) most patients took concomitant therapies and recovered after lithium withdrawal, (3) some patients were female and old-aged (65+ years old), and (4) no ethnicities, causality assessments and dose patterns were reported. Other scientific literature showed (1) frequencies of a lithium-induced confusional state varied from very common (>10%) to rare (<0.01%), (2) inhibition of inositol phosphate-phosphatase (IMPase) and glycogen synthase kinase-3 (GSK3) might result in a lithium-induced confusional state, (3) ageing, diseases and concomitant therapies increased the risk of a lithium-induced confusional state, and (4) patients should complete lab tests and diagnostic procedures to monitor and/or prevent a lithium-induced confusional state. Conclusion: Case reports and other scientific literature elucidated the relationship between lithium and a confusional state.

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Subclinical Hypothyroidism

Fatourechi

2002

Treatments in Endocrinology

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The term 'subclinical hypothyroidism' applies to patients who have mildly increased levels of serum thyrotropin hormone (TSH) and normal levels of thyroxine and liothyronine (triiodiothyronine). This very common condition, also called 'mild thyroid failure', accounts for 75% of patients who have increased serum TSH. For patients with sustained increases above 10 mIU/L, there is uniform agreement that thyroxine therapy is indicated. Therapy for milder forms of hypothyroidism is controversial. Some randomized clinical trials favor therapy for mild thyroid failure, but they are inconclusive because they lack stratification for the subgroup of patients with TSH levels below 10 mIU/L. For this subgroup, we recommend individualized management. The presence of goiter, positive thyroperoxidase (TPO) antibodies, manic-depressive disorder, fertility problems, or pregnancy or the anticipation of pregnancy favors the initiation of therapy. Positive TPO antibodies are a strong indication for therapy because of the high likelihood in these patients of progression to overt hypothyroidism; patients who are already receiving thyroxine should have adjustments of their dosage. Children and adolescents with mild thyroid failure should also be treated because of possible adverse effects on growth and development. It has been suggested that subclinical hypothyroidism is a cardiovascular risk factor, however further investigation is needed. The controversy surrounding therapy will not be resolved until more randomized studies are available for the subgroup of patients with TSH <10 mIU/L, and until the question of cardiovascular risk factors is further clarified.

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Subclinical hypothyroidism in recurrent mania

Cited by 3 publications

References 1 publication

Rapid cycling bipolar disease: New concepts and treatments

Rapid cycling bipolar disease: New concepts and treatments

Lithium carbonate-induced confusional state in patients with bipolar disorder: identification of case reports and review of the evidence

Subclinical Hypothyroidism

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