The Use of Lithium Medications in Psychiatric Practice in the Context of Their Effect on the Thyroid Status

Abstract

Lithium has a wide range of beneficial pharmacological effects and is practically a single option drug in some patients with bipolar affective disorder. At the same time, lithium can cause changes in the structure and function of the thyroid gland. Hypothyroidism and goiter are the most common thyroid disorders in patients receiving long-term lithium therapy. Hence, psychiatrists may have doubts about the safety of administering lithium to patients with thyroid pathology. Additional difficulties may arise when a patient is found to have lithium-induced thyroid disorders. This topic is not sufficiently covered in domestic manuals on psychiatry. That is why the purpose of this article is to review modern literature sources on the effect of lithium on the thyroid gland, recommendations for monitoring lithium-induced thyroid disorders and ways to correct the developing pathology. The article discusses possible mechanisms of disorders in the structure and functioning of the thyroid gland during lithium treatment. Literature data on the influence of gender, ethnicity and duration of lithium therapy on the development of thyroid pathology are presented. The article presents the algorithm for the safe use of lithium medications in the aspect of thyroid pathology. If the thyroid function is slightly reduced during the initial examination, lithium can be prescribed if necessary, but hypothyroidism should be treated with sodium levothyroxine. In the presence of difficult-to-correct hypothyroidism, it is recommended to choose another mood stabilizing agent. Lithium preparations are the most important component in the complex treatment of bipolar affective disorder. Withholding therapy due to the developed thyroid pathology, which is well corrected with medications and more often has a transient character, is not justified. For safe lithium treatment, it is important to monitor the main parameters of the thyroid gland in a timely manner before and during therapy.