Ultrasonographically Measured Change in Thyroid Status in Lithium Treated Adult Patients with Mood Disorder

Alam, Sekh Afrar; Sinha, Vinod Kumar; Nizamie, Haque S

doi:10.4103/0253-7176.178774

Cited by 3 publications

(2 citation statements)

References 33 publications

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“…On the other hand, Ozsoy, Mavili, Aydin, Turan, and Esel () found lower fT4 in the long‐term lithium‐treated patients and decreased fT3 in lithium‐naïve subjects after lithium treatment. Alam, Sinha, and Nizamie () in patients treated with lithium found higher concentrations of both total T4 and total T3. The increase of fT4 found in our long‐term lithium‐treated patients can also be seen as a compensatory phenomenon to lithium inhibition of thyroid function.…”

Section: Discussionmentioning

confidence: 89%

Thyroid structure and function in long‐term lithium‐treated and lithium‐naïve bipolar patients

Kraszewska

Ziemnicka

Jończyk‐Potoczna

et al. 2019

Human Psychopharmacology

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Objective The aim of the study was to compare the structure and function of the thyroid in patients with bipolar disorder (BD) receiving long‐term lithium treatment, with BD patients never receiving lithium. Methods Ninety‐eight patients (68 female and 30 male), aged 62 ± 13 years, receiving lithium for 3–47 years (mean 19 ± 10 years), and 39 patients (27 female and 12 male), aged 57 ± 10 years, receiving other mood‐stabilizing drugs but never treated with lithium, were included. The thyroid‐stimulating hormone (TSH), free triiodothyronine (fT3), and free thyroxine (fT4) were estimated, and the ultrasonographic study of the thyroid gland was performed. Results Compared with patients not receiving lithium, lithium‐treated patients had significantly higher concentrations of TSH and fT4 and the lower concentration of fT3. However, the percentage of hypothyroidism was not different in both groups. Lithium‐treated patients also had significantly higher thyroid volume, the higher number of focal changes >1 cm, and more frequent goiter. The structural changes were not related to the hormones' concentrations. Conclusions The results show a significant association between long‐term lithium treatment and the increase of TSH and fT4, the decrease of fT3, higher thyroid volume, and more frequent goiter and nodular goiter. The effect of lithium on thyroid structure was not associated with its effect on thyroid hormones.

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Section: Discussionmentioning

confidence: 89%

Thyroid structure and function in long‐term lithium‐treated and lithium‐naïve bipolar patients

Kraszewska

Ziemnicka

Jończyk‐Potoczna

et al. 2019

Human Psychopharmacology

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“…were it was found that lithium treatment is associated with increased individual mean thyroid lobe volume and overall mean thyroid volumes. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Background: Although lithium is known to cause thyroid dysfunction and increased thyroid gland volume, clinical examination and biochemical assessment are fundamental to thyroid workup of patients on lithium treatment. We aimed to determine thyroid gland volume and the Thyroid hormone levels of patients who have been receiving lithium treatment for affective disorders in comparison to voluntary healthy controls. Methods: This was a cross-sectional, hospital-based observational study which was performed in 43 patients on long-term lithium treatment for bipolar disorder, major depressive and schizoaffective disorders. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months recruited consecutively underwent the ultrasonographic examination of the thyroid gland. Ultrasonographic examinations were also done in all gender- and age-matched healthy controls. All cases and controls underwent biochemical thyroid function tests. Results: There were no statistically significant differences in gender ( P = 0.198; Chi-square = 1.654) of cases and controls. Most of the cases were married, maximum number of them unemployed and belonged to the lower socioeconomic status. Total thyroid volume was significantly greater in the lithium-treated group than the controls (9.40 ± 1.41 vs. 4.79 ± 0.45). Clinical inspection and palpation only detected goiter in six ( n = 6, 13.95%) of patients on lithium and none among controls. The mean triiodothyronine, mean thyroxine, and mean scores for thyroid-stimulating hormone were significantly increased in patients receiving lithium therapy as compared to controls. Conclusion: It would seem wise from a clinical point of view to include ultrasonographic examination of the thyroid gland as part of the standard thyroid workup before initiating lithium treatment.

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Insights into the Incidence, Course, and Management of Lithium-Induced Hypothyroidism in Real-World Psychiatric Practice in Italy

Pardossi,

Pinzi,

Cattolico

et al. 2024

Pharmaceuticals

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Background: Lithium is a cornerstone in the treatment of bipolar disorder (BD). However, lithium use requires careful monitoring of thyroid function due to associated dysfunctions. The aim of our real-world study is to retrospectively evaluate the impact of lithium on thyroid function and how these thyroid alterations can be measured and managed. Methods: A retrospective observational study was performed on 150 patients with BD who started lithium treatment at the University Hospital of Siena. Thyroid function was assessed at baseline and after the introduction of lithium by measuring TSH, T3, and T4 levels at baseline and after 3, 6, 9, and 12 months, during which changes in psychiatric symptoms were also evaluated using specific psychometric scales. Results: Significant increases in TSH levels were observed at 3 and 6 months, while T3 and T4 levels decreased significantly at 3 months. Transient thyroid dysfunction occurred in 36.7% of patients, but normalized without the discontinuation of lithium or need for thyroid replacement therapy in most cases; however, replacement therapy was initiated in 8.7% of patients. There were no significant differences in treatment response between patients with and without thyroid abnormalities, as the abnormalities were transient or resolved. Conclusions: In our sample, lithium induced some cases of hypothyroidism, which, being transient or corrected with replacement therapy, did not interfere with symptomatic improvement. These findings underscore the necessity for continuous thyroid function monitoring during lithium therapy. Clinicians should be prepared to initiate thyroid replacement therapy, when necessary, as timely management can prevent the interruption of lithium treatment and ensure ongoing symptomatic improvement in BD patients. Future studies could include larger and more diverse populations to validate these findings further, extending the follow-up period beyond 12 months to better observe long-term thyroid function trends and management outcomes.

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Ultrasonographically Measured Change in Thyroid Status in Lithium Treated Adult Patients with Mood Disorder

Cited by 3 publications

References 33 publications

Thyroid structure and function in long‐term lithium‐treated and lithium‐naïve bipolar patients

Thyroid structure and function in long‐term lithium‐treated and lithium‐naïve bipolar patients

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

Insights into the Incidence, Course, and Management of Lithium-Induced Hypothyroidism in Real-World Psychiatric Practice in Italy

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