Thyroid hormone levels and ultrasonographic changes in the thyroid gland of patients on long-term Lithium treatment for affective disorders: A controlled study

Dar, Shabir Ahmad; Bhat, Bilal Ahmad; Khanam, Aaliya; Wani, Zaid Ahmad; Nabi, Junaid; Sheikh, Shanoo

doi:10.4103/jmu.jmu_26_19

Cited by 5 publications

(2 citation statements)

References 28 publications

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“…Some studies suggest a higher risk in females, the elderly, and individuals with diabetes 13 . Small case-control studies conducted in India have suggested thyroid gland enlargement and higher average TSH levels in individuals undergoing Lithium treatment 14,15 . However, prospective studies with follow-up duration between 2-15 years provide inconclusive findings.…”

Section: Introductionmentioning

confidence: 99%

Association between Lithium and thyroid function: a retrospective study

Agarwal,

David,

Mahadevan

et al. 2024

Preprint

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IntroductionBipolar Disorder (BD) is associated with thyroid dysfunction, and literature on the clinical impact of Lithium on thyroid function in BD patients remains inconsistent. Thus, we aimed to systematically estimate the prevalence of thyroid dysfunction in Lithium treated BD patients, explore the clinical factors associated with the development of hypothyroidism and time to detection of thyroid dysfunction after Lithium initiation.MethodsA retrospective review of BD patients with a follow-up between Jan to Dec 2019 was conducted. Patients with no pre-existing thyroid dysfunction and at least six months of cumulative exposure to Lithium were included. For the included 444 patients, sociodemographic, clinical variables and laboratory assessment values were charted systematically. Patients with TSH > 5 mIU/L were classified as hypothyroid.Results27.7% (n=123) developed thyroid dysfunction; 27.3% (n=121) developed hypothyroidism after Lithium exposure. The median duration of detection of hypothyroidism was 33.6 months for females and 38.4 months for males, with no significant difference across genders (p=.52). A significantly higher proportion of females (49.5%) developed hypothyroidism as opposed to males (23.7%). Hypothyroid females differed significantly with respect to comorbid diabetes mellitus and hypertension; from euthyroid females. First-episode depression was associated with hypothyroidism in males. However, multivariate analyses did not detect any associations.DiscussionOne-fourth of Lithium-treated patients developed hypothyroidism. This risk was higher in female patients, with onset close to 33 months, indicating the need for closer monitoring for long durations. The impact of hypothyroidism on prognosis and response to treatment needs further exploration.

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Section: Introductionmentioning

confidence: 99%

Association between Lithium and thyroid function: a retrospective study

Agarwal,

David,

Mahadevan

et al. 2024

Preprint

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“…Even though many investigations reported that low levels of Li + are precious in mitigating signs of bipolar disorders and depression ( 6 – 8 ) found that prolonged exposure to therapeutic doses of Li + triggers complications among hospitalized patients ( 8 ). Hence, toxicity in the renal system ( 9 – 11 ), nervous system ( 12 ), thyroid glands (goiter) ( 13 ), and dermatological-related complications ( 14 , 15 ), as well as circulatory system ( 16 ) under Li + exposure have been earlier reported. On the other hand, it has been shown that this light metal can pass across the placental barriers and then induce teratogenic effects ( 17 , 18 ).…”

Section: Introductionmentioning

confidence: 99%

The Role of Mitochondrial Impairment and Oxidative Stress in the Pathogenesis of Lithium-Induced Reproductive Toxicity in Male Mice

et al. 2021

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Lithium (Li+) is prescribed against a wide range of neurological disorders. Besides its excellent therapeutic properties, there are several adverse effects associated with Li+. The impact of Li+ on renal function and diabetes insipidus is the most common adverse effect of this drug. On the other hand, infertility and decreased libido is another complication associated with Li+. It has been found that sperm indices of functionality, as well as libido, is significantly reduced in Li+-treated men. These adverse effects might lead to drug incompliance and the cessation of drug therapy. Hence, the main aims of the current study were to illustrate the mechanisms of adverse effects of Li+ on the testis tissue, spermatogenesis process, and hormonal changes in two experimental models. In the in vitro experiments, Leydig cells (LCs) were isolated from healthy mice, cultured, and exposed to increasing concentrations of Li+ (0, 10, 50, and 100 ppm). In the in vivo section of the current study, mice were treated with Li+ (0, 10, 50, and 100 ppm, in drinking water) for five consecutive weeks. Testis and sperm samples were collected and assessed. A significant sign of cytotoxicity (LDH release and MTT assay), along with disrupted testosterone biosynthesis, impaired mitochondrial indices (ATP level and mitochondrial depolarization), and increased biomarkers of oxidative stress were detected in LCs exposed to Li+. On the other hand, a significant increase in serum and testis Li+ levels were detected in drug-treated mice. Moreover, ROS formation, LPO, protein carbonylation, and increased oxidized glutathione (GSSG) were detected in both testis tissue and sperm specimens of Li+-treated mice. Several sperm anomalies were also detected in Li+-treated animals. On the other hand, sperm mitochondrial indices (mitochondrial dehydrogenases activity and ATP levels) were significantly decreased in drug-treated groups where mitochondrial depolarization was increased dose-dependently. Altogether, these data mention oxidative stress and mitochondrial impairment as pivotal mechanisms involved in Li+-induced reproductive toxicity. Therefore, based on our previous publications in this area, therapeutic options, including compounds with high antioxidant properties that target these points might find a clinical value in ameliorating Li+-induced adverse effects on the male reproductive system.

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The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

et al. 2022

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Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multiomic" measures, electronic health records), analyzed using ad vanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at pointofcare is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features -especially during depressive episodes -and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentallyoriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, provid ing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at pointofcare.

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Thyroid hormone levels and ultrasonographic changes in the thyroid gland of patients on long-term Lithium treatment for affective disorders: A controlled study

Cited by 5 publications

References 28 publications

Association between Lithium and thyroid function: a retrospective study

Association between Lithium and thyroid function: a retrospective study

The Role of Mitochondrial Impairment and Oxidative Stress in the Pathogenesis of Lithium-Induced Reproductive Toxicity in Male Mice

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

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