Thyroid abnormalities during lithium treatment

Abstract

Thyroid function was evaluated in 150 Sardinian outpatients at different stages of lithium treatment. A visible and/or palpable goitre was found in 51% of patients, and there was no apparent correlation with the duration of treatment. No cases of symptomatic hypothyroidism were observed, but subclinical hypothyroidism was present in 19% of patients. The prevalence of specific antithyroid antibodies was positively correlated with age and duration of lithium treatment, and was higher in women. Subclinical hypothyroidism was observed in 53% of antibody-positive lithium-treated patients. Carbamazepine in combination with lithium was associated with significantly lower levels of total T4 and T3 than with lithium alone, and the ratios between total and free hormones were also decreased.

Correlation of serum lithium levels and thyroid function tests in subjects of bipolar affective disorder: a prospective hospital-based study

“…The prevalence of specifi c anti-thyroid antibodies was positively correlated with age and duration of lithium treatment, and was higher among women. 16 Bocchetta et al and Chakrabarti concluded that risk of developing lithium-induced hypothyroidism has been shown to be signifi cantly higher among females, with increasing age (>50 years), presence of family history of thyroid disease and thyroid auto-antibodies.…”

Lithium safety and tolerability in mood disorders: a critical review

“…The incidence of thyroid goiter was present in 51% of 150 outpatients evaluated in a clinical observational study 38 . In this study, 19% of subjects had subclinical hypothyroidism and 53% were positive for the presence of anti-thyroid antibodies, despite the absence of clinical cases of hypothyroidism, and positively correlated with age and time of lithium treatment.…”

“…Amiloride is preferable to others diuretics as it less likely affects lithium levels, given its ability to block lithium uptake at the epithelial sodium channel 90 . Drugs that lower lithium concentrations by increasing the clearance are theophylline, acetazolamide, mannitol and caffeine 38 .…”

Lithium Therapy and Thyroid Disorders

“…The incidence is estimated to be 40 to 50% of patients treated with lithium [13][14][15], with a bias on gender, duration of treatment, and geographical location, which is likely related to dietary iodine content. When goiter formation occurs, it usually happens within the first two years of lithium treatment.…”