Thyroid abnormalities in lithium-treated patients
The purposes of this study were to evaluate possible effects of lithium on thyroid function, determine the relationship among thyroid function, antibody levels, and demographic/clinical variables, and establish the prevalence of lithiumrelated goiter, clinical hypothyroidism, and thyroid antibodies. Forty-nine patients who had taken lithium for a minimum of 6 months were enrolled, as were 46 age- and sex-matched controls naïve to lithium use. Blood was drawn to measure levels of total and free T3, T4, thyroid-stimulating hormone (TSH), and antimicrosomal and antithyroglobulin antibodies. Thyroid volume was quantified on ultrasonography. Twenty-nine patients in the study group (59%) and 7 in the control group (15%) had goiter. Free T4 levels were significantly lower in the study group, and TSH levels were higher. Among lithium-treated patients, 12% had clinical hypothyroidism and 2% had subclinical hypothyroidism. Thyroid antibodies were present in 23% of the lithium group and 15% of the control group. No significant relationship was apparent among thyroid antibodies, thyroid volume, and clinical hypothyroidism. Our findings suggested that along with its goitrogenic effects, lithium inhibited thyroid function and led to clinical hypothyroidism. Older age, family history of thyroid disorders, and the presence of thyroid antibodies significantly influenced thyroid function in the present study.
Keywordslithium thyroid hypothyroidism goiter thyroid antibodies
Jacobson JL, Jacobson MA. Mood-stabilizing agents. In: Jacobson JL, ed.Psychiatric Secrets
. Canada: Times Mirror Professional Publishing; 1996:277–285.Google Scholar
Fernandez BA. Autoimmune thyrotoxicosis during lithium therapy in a patient with manicdepressive illness.Am J Med.
Honig A, Arts BMG, Ponds RHWM, Riedel WJ. Lithium induced cognitive side-effects in bipolar disorder: a qualitative analysis and implications for daily practice.Int Clin Psychopharmacol.
1999; 14:167–171.PubMedCrossRefGoogle Scholar
Deodhar SD, Sing B, Pathak MC, Sharan P, Kulhara P. Thyroid functions in lithium-treated psychiatric patients.Biol Trace Element Res.
Gekenberg JA, Hopkins SH, Delgada LP. Mood stabilizers. In: Tasman A, Kay J, Lieberman AJ, eds.Psychiatry
. Philadelphia: WB Saunders; 1997:1586–1605.Google Scholar
Kleiner J, Altshuler L, Hendrick V, Hersman MJ. Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment.J Clin Psychiatry
. 1999;60:255–294.CrossRefGoogle Scholar
Bhandari S. Lithium-induced hypothyroidism.Br J Psychiatry
. 2000;176:95.PubMedCrossRefGoogle Scholar
Johnston MA, Eagles MJ. Lithium-associated clinical hypothyroidism.Br J Psychiatry
. 1999;175: 336–339.PubMedCrossRefGoogle Scholar
Bocchetta A, Bernardi F, Pedditzi M, et al. Thyroid abnormalities during lithium treatment.Acta Psychiatr Scand
. 1991;83:193–198.PubMedCrossRefGoogle Scholar
Hassman AR, Lazarus HJ, Dieguez C, Weetman AP, Hall R, McGregor AM. The influence of lithium chloride on experimental autoimmune thyroid disease.Clin Exp Immunol.
Deniker P, Eyquem A, Bernheim R, Loo H, Delarue P. Thyroid autoantibody levels during lithium therapy.Neuropsychobiology
. 1978;4:270–275.PubMedCrossRefGoogle Scholar
Rapaport HM, Schmit EM, Risinger R, Manji H. The effects of prolonged lithium exposure on the immune system of normal control subjects: serial serum soluble interleukin-2 receptor and antithyroid antibody measurements.Biol Psychiatry
. 1994;35:761–766.PubMedCrossRefGoogle Scholar
Shimizu M, Hirokawa M, Manabe T, Shimozuma K, Sonoo H, Harada T. Lithium associated autoimmune thyroiditis.J Clin Pathol.
Lazarus HJ, McGregor MA, Ludgate M, Darke C, Creagh MF, Kingswood JC. Effect of lithium carbonate therapy on thyroid immune status in manic depressive patients: a prospective study.J Affect Disord
. 1986;11:155–160.PubMedCrossRefGoogle Scholar
Lee S, Chow CC, Wing KY, Shek CC. Thyroid abnormalities during chronic lithium treatment in Hong Kong Chinese: a controlled study.J Affect Disord
. 1992;26:173–178.PubMedCrossRefGoogle Scholar
Leroy MC, Villeneuve A, Lajeunesse C. Lithium, thyroid function and antithyroid antibodies.Biol Psychiatry
. 1988;12:483–490.Google Scholar
Kirov G. Thyroid disorders in lithium-treated patients.J Affect Disord
. 1998;50:33–40.PubMedCrossRefGoogle Scholar
Perrild H, Hegedus L, Baastrup PC, Kayser L, Kastberg S. Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment.Am J Psychiatry
. 1990; 147:1518–1521.PubMedGoogle Scholar
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders
. 4th ed. Washington, DC: American Psychiatric Association; 1994.Google Scholar
Lee S, Chow CC, Wing YK, et al. Thyroid function and psychiatric morbidity in patients with manic disorder receiving lithium therapy.J Clin Psychopharmacol.
Bocchetta A, Cherchi A, Loviselli A, et al. Six-years follow-up of thyroid function during lithium treatment.Acta Psychiatr Scand
. 1996;94:45–48.PubMedCrossRefGoogle Scholar
Loviselli A, Bocchetta A, Mossa P, et al. Value of thyroid echography in the long-term follow-up of lithium-treated patients.Neuropsychobiology
. 1997;36:37–41.PubMedCrossRefGoogle Scholar
Kusalic M, Engelsmann F. Effect of lithium maintenance therapy on thyroid and parathyroid function.J Psychiatry Neurosci
. 1999;24:227–233.PubMedGoogle Scholar
Yamagishi S, Yokoyama-ohta M. A case of lithium-associated hyperthyroidism.Postgrad Med.
Sawin CT, Castelli WP, Hershman JM, McNamara P, Bacharach P. The aging thyroid: thyroid deficiency in the Framingham study.Arch Intern Med.
Wilson R, McKillop HJ, Crocket GT, et al. The effect of lithium therapy on parameters thought to be involved in the development of autoimmune thyroid disease.Clin Endocrinol.
1991;34: 357–361.Google Scholar
Valle J, Ayuso-Gutierrez JL, Abril A, Ayuso-Mateos LJ. Evaluation of thyroid function in lithiumnaive bipolar patients.Eur Psychiatry
. 1999;14:341–345.PubMedCrossRefGoogle Scholar
Frye AM, Kirk D, Denicoff K, et al. Association between lower serum free T4 and greater mood instability and depression in lithium-maintained bipolar patients.Am J Psychiatry
. 1999;156: 1909–1914.PubMedGoogle Scholar
Kupka RW, Hillegers MHJ, Nolen WA, Breunis N, Drexhage HA. Immunological aspects of bipolar disorder.Bipolar Disord
. 2000;12:86–90.Google Scholar
Hagherty JJ, Silva SG, Marquardt M, et al. Prevalence of antithyroid antibody in mood disorder.Depress Anxiety
. 1997;5:91–96.CrossRefGoogle Scholar
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