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Lithium Therapy and Hyperparathyroidism: An Evidence-Based Assessment

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Abstract

Background

Prolonged therapeutic exposure to lithium compounds can have adverse consequences on calcium homeostasis. A unique form of hyperparathyroidism appears to be causally linked to chronic lithium exposure. We provide a comprehensive review of relevant literature using a structured, evidence-based approach.

Methods

Published data were identified from systematic electronic literature searches. References are assigned a level of evidence according to a validated classification schema.

Results

Level III and V evidence supports an etiologic link between sustained lithium therapy and both hypercalcemia and hyperparathormonemia (grade C recommendation). Level V evidence supports the use of preoperative parathyroid imaging if a focused exploration is planned (grade C recommendation). Level V evidence supports the use of intraoperative parathyroid hormone monitoring to guide appropriate surgical therapy (grade C recommendation). There is conflicting and equally weighted level V evidence supporting a routine preoperative plan of bilateral neck exploration versus selective unilateral exploration (no recommendation). There may be a role for calcimimetic drug therapy as an alternate, nonsurgical means of controlling lithium-associated hyperparathyroidism (grade C recommendation).

Conclusions

Evidence-based recommendations support screening of patients on chronic lithium therapy for hypercalcemia. Appropriate surgical therapy may consist of either a bilateral or a unilateral approach when performed by an experienced endocrine surgeon. Focused approaches should be guided by preoperative imaging and intraoperative hormone monitoring. Calcimimetic therapy is a potential alternative to parathyroidectomy.

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Authors and Affiliations

  1. Department of Surgery, Pennsylvania State Milton S. Hershey Medical Center, Penn State University College of Medicine, Mail Code H070, 500 University Drive, PO Box 850, Hershey, 17033-0850, PA, USA

    Brian D. Saunders

  2. Department of Psychiatry, Penn State University College of Medicine, Hershey, PA, USA

    Erika F. H. Saunders

  3. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Paul G. Gauger

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  1. Brian D. Saunders
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Saunders, B.D., Saunders, E.F.H. & Gauger, P.G. Lithium Therapy and Hyperparathyroidism: An Evidence-Based Assessment. World J Surg 33, 2314–2323 (2009). https://doi.org/10.1007/s00268-009-9942-4

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