1
|
El-Din WAN, Fadel R, Rashid A, Al-Mahameed AE, Othman MA. Pomegranate (Punica granatum) peel alleviates lithium-induced alterations in the thyroid gland of rats by modulating apoptosis and oxidative stress. Anat Rec (Hoboken) 2023; 306:537-551. [PMID: 36370004 DOI: 10.1002/ar.25122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/05/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Lithium carbonate (LC) is known to alter thyroid gland function. Pomegranate (PG) is a fruit with multiple antioxidant and antiapoptotic properties. Here, we studied the effect of PG on LC-induced morphological and functional alterations in the thyroid glands of rats. Rats were divided into four groups: control, lithium, lithium-PG, and PG. After 8 weeks, the rats were sacrificed, the levels of thyroid hormones and oxidative stress markers were estimated, and thyroid tissues were subjected to histological, immunohistochemical, and ultrastructural evaluations. Compared to the control group, the lithium group showed significant changes in thyroid hormone levels, greater expression of the oxidant marker malondialdehyde, and lower expression of the antioxidant marker superoxide dismutase (SOD). Most of these changes improved upon PG treatment. Histological evaluation of the thyroid in the lithium group showed disorganization and follicle involution. Additionally, the periodic acid Schiff staining intensity and SOD immunoreactivity declined significantly, whereas the collagen fiber content and Bax immunoreactivity increased. The follicular ultrastructure showed marked distortion. These changes were mitigated upon PG treatment. In conclusion, PG alleviated the morphological and functional changes in the thyroid glands induced by LC by modulating apoptosis and oxidative stress.
Collapse
Affiliation(s)
- Wael Amin Nasr El-Din
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.,Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Raouf Fadel
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.,Department of Human Anatomy and Embryology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Aisha Rashid
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ali E Al-Mahameed
- Department of Microbiology, Immunology and Infectious diseases, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Manal A Othman
- Department of Anatomy, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain.,Department of Histology and Cell Biology, Faculty of Medicine, Assiut University, Assiut, Egypt
| |
Collapse
|
2
|
Meurisse M, Preudhomme L, Lamberty G, Meurisse N, Bataille Y, Defechereux T, Hamoir E. Iatrogenic Thyrotoxicosis. Causal Circumstances, Pathophysiology and Principles of Treatment. Review of the Literature. Acta Chir Belg 2020. [DOI: 10.1080/00015458.2001.12098632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- M. Meurisse
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - L. Preudhomme
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - G. Lamberty
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - N. Meurisse
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - Y. Bataille
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - Th. Defechereux
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| | - E. Hamoir
- Department of Endocrine Surgery and Transplantation, Centre Hospitalier Universitaire de Liège, B35, 4000 Liège, Belgium
| |
Collapse
|
3
|
An Adolescent Female with Bipolar Disorder Presenting with Lithium-Induced Hyperthyroidism. Case Rep Endocrinol 2020; 2020:1283464. [PMID: 32099690 PMCID: PMC7037979 DOI: 10.1155/2020/1283464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
Lithium therapy has been associated with several endocrine disorders including thyroid dysfunction, diabetes insipidus, and hyperparathyroidism. While its suppressive effect on thyroid function is well known, it is very rare to observe lithium-induced hyperthyroidism especially in the pediatric population. Here, we describe a case of lithium-induced hyperthyroidism in an adolescent female with bipolar disorder. The patient is a 17-year-old female who was treated with lithium for bipolar disorder and presented with symptoms and laboratory findings consistent with hyperthyroidism. Since thyroid autoantibodies were negative, thyroid dysfunction was attributed to lithium toxicity. Indeed, her clinical and biochemical hyperthyroid state resolved after stopping lithium therapy. Lithium-associated hyperthyroidism can occur in the pediatric population. We propose close monitoring of thyroid hormone levels in children on lithium therapy.
Collapse
|
4
|
Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 708] [Impact Index Per Article: 141.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
5
|
Fairbrother F, Petzl N, Scott JG, Kisely S. Lithium can cause hyperthyroidism as well as hypothyroidism: A systematic review of an under-recognised association. Aust N Z J Psychiatry 2019; 53:384-402. [PMID: 30841715 DOI: 10.1177/0004867419833171] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Hypothyroidism is a well-documented consequence of lithium treatment. Less well known is a possible association between lithium therapy and hyperthyroidism. This may have clinical implications as rapid changes in thyroid hormones may worsen a person's affective state, while symptoms of hyperthyroidism can mimic those of mania. We therefore systematically reviewed the published literature for evidence of lithium-induced hyperthyroidism. METHODS We searched PubMed, Embase and CINAHL for articles where individuals developed biochemically confirmed hyperthyroidism (with or without clinical symptoms), while on lithium therapy for an affective illness. We included case reports, case series, cross-sectional, case control and cohort studies. RESULTS We included 52 studies, 39 of which were individual case reports and 3 were case series. There were 10 cross-sectional or case control or cohort studies. All the research designs suggested an association between the prescription of lithium and hyperthyroidism. However, these findings were limited by the quality of the included studies, small number of participants and the general lack of either a clear temporal relationship or dose response. CONCLUSION Hyperthyroidism is an uncommon side-effect of lithium compared to hypothyroidism but may have clinical implications. However, large prospective studies are required to clarify this association and to further inform the management of patients treated with lithium where hyperthyroidism occurs.
Collapse
Affiliation(s)
- Fiona Fairbrother
- 1 Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Nicola Petzl
- 2 West Moreton Health Service, Ipswich, QLD, Australia
| | - James G Scott
- 1 Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,3 Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,4 Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia
| | - Steve Kisely
- 2 West Moreton Health Service, Ipswich, QLD, Australia.,5 Metro South Mental Health, Woolloongabba, QLD, Australia.,6 School of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| |
Collapse
|
6
|
Arathil P, Mathew K, Narayanan D. Lithium-induced Thyroiditis in a Patient Having Bipolar Affective Disorder - A Rare Case Report. Indian J Psychol Med 2018; 40:577-579. [PMID: 30533956 PMCID: PMC6241188 DOI: 10.4103/ijpsym.ijpsym_403_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 22-year-old female, previously diagnosed with bipolar affective disorder on lithium therapy, presented to us with manic symptoms. The blood investigations revealed elevated thyroxine and thyroid peroxidase antibodies and reduced thyroid-stimulating hormone with poor tapping function of thyroid on technetium thyroid scintigraphy indicating lithium-induced thyroiditis.
Collapse
Affiliation(s)
- Praveen Arathil
- Department of Psychiatry, Amrita Institute of Medical Sciences and Research Institute, Kochi, Kerala, India
| | - Kotchuthressia Mathew
- Department of Psychiatry, Amrita Institute of Medical Sciences and Research Institute, Kochi, Kerala, India
| | - Dinesh Narayanan
- Department of Psychiatry, Amrita Institute of Medical Sciences and Research Institute, Kochi, Kerala, India
| |
Collapse
|
7
|
Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid 2016; 26:1343-1421. [PMID: 27521067 DOI: 10.1089/thy.2016.0229] [Citation(s) in RCA: 1284] [Impact Index Per Article: 160.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Thyrotoxicosis has multiple etiologies, manifestations, and potential therapies. Appropriate treatment requires an accurate diagnosis and is influenced by coexisting medical conditions and patient preference. This document describes evidence-based clinical guidelines for the management of thyrotoxicosis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition. METHODS The American Thyroid Association (ATA) previously cosponsored guidelines for the management of thyrotoxicosis that were published in 2011. Considerable new literature has been published since then, and the ATA felt updated evidence-based guidelines were needed. The association assembled a task force of expert clinicians who authored this report. They examined relevant literature using a systematic PubMed search supplemented with additional published materials. An evidence-based medicine approach that incorporated the knowledge and experience of the panel was used to update the 2011 text and recommendations. The strength of the recommendations and the quality of evidence supporting them were rated according to the approach recommended by the Grading of Recommendations, Assessment, Development, and Evaluation Group. RESULTS Clinical topics addressed include the initial evaluation and management of thyrotoxicosis; management of Graves' hyperthyroidism using radioactive iodine, antithyroid drugs, or surgery; management of toxic multinodular goiter or toxic adenoma using radioactive iodine or surgery; Graves' disease in children, adolescents, or pregnant patients; subclinical hyperthyroidism; hyperthyroidism in patients with Graves' orbitopathy; and management of other miscellaneous causes of thyrotoxicosis. New paradigms since publication of the 2011 guidelines are presented for the evaluation of the etiology of thyrotoxicosis, the management of Graves' hyperthyroidism with antithyroid drugs, the management of pregnant hyperthyroid patients, and the preparation of patients for thyroid surgery. The sections on less common causes of thyrotoxicosis have been expanded. CONCLUSIONS One hundred twenty-four evidence-based recommendations were developed to aid in the care of patients with thyrotoxicosis and to share what the task force believes is current, rational, and optimal medical practice.
Collapse
Affiliation(s)
- Douglas S Ross
- 1 Massachusetts General Hospital , Boston, Massachusetts
| | - Henry B Burch
- 2 Endocrinology - Metabolic Service, Walter Reed National Military Medical Center , Bethesda, Maryland
| | - David S Cooper
- 3 Division of Endocrinology, Diabetes, and Metabolism, The Johns Hopkins University School of Medicine , Baltimore, Maryland
| | | | - Peter Laurberg
- 5 Departments of Clinical Medicine and Endocrinology, Aalborg University and Aalborg University Hospital , Aalborg, Denmark
| | - Ana Luiza Maia
- 6 Thyroid Section, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Scott A Rivkees
- 7 Pediatrics - Chairman's Office, University of Florida College of Medicine , Gainesville, Florida
| | - Mary Samuels
- 8 Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University , Portland, Oregon
| | - Julie Ann Sosa
- 9 Section of Endocrine Surgery, Duke University School of Medicine , Durham, North Carolina
| | - Marius N Stan
- 10 Division of Endocrinology, Mayo Clinic , Rochester, Minnesota
| | - Martin A Walter
- 11 Institute of Nuclear Medicine, University Hospital Bern , Switzerland
| |
Collapse
|
8
|
Abd El-Twab SM, Abdul-Hamid M. Curcumin mitigates lithium-induced thyroid dysfunction by modulating antioxidant status, apoptosis and inflammatory cytokines. THE JOURNAL OF BASIC & APPLIED ZOOLOGY 2016; 76:7-19. [DOI: 10.1016/j.jobaz.2016.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
9
|
Alam SA, Sinha VK, Nizamie H. Ultrasonographically Measured Change in Thyroid Status in Lithium Treated Adult Patients with Mood Disorder. Indian J Psychol Med 2016; 38:120-6. [PMID: 27114623 PMCID: PMC4820550 DOI: 10.4103/0253-7176.178774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Lithium, which is frequently used in the treatment of mood disorder, can lead to various types of thyroid dysfunctions. Although clinical examination and biochemical assessment are fundamental to any thyroid work-up of lithium-treated patients, assessment findings vary widely depending on the investigator. Ultrasonographic measurement of thyroid volume has, therefore, been performed in lithium treatment populations and found to be a sensitive tool. AIM We aimed to determine and compare thyroid gland volume using Ultrasonography and laboratory parameters, (thyroid-stimulating hormone [TSH], T3, and T4) in long-term lithium and other mood stabilizers treated patients with mood disorder. MATERIALS AND METHODS In this cross-sectional study, we performed ultrasonography examinations and thyroid function test of 30 patients on lithium treatment and 30 patients on other mood stabilizers. RESULTS The ultrasonographically measured thyroid volume was significantly increased in patients receiving lithium therapy as compared to the patients receiving other mood stabilizers. The total triiodothyronine (T3) was significantly increased with trends toward increased total thyroxine (T4) and decreased TSH in patients receiving lithium therapy as compared to the patients receiving other mood stabilizers. CONCLUSION These results highlight the need of including ultrasonographic measurement of thyroid volume as a part of standard thyroid work-up before initiating lithium prophylaxis and during follow-up. Additional studies on the incidence and mechanism of lithium associated hyperthyroidism are needed.
Collapse
Affiliation(s)
- Sekh Afrar Alam
- Academic Section, LGB Regional Institute of Mental Health, Department of Psychiatry, Tezpur, Assam, India
| | | | - Haque Nizamie
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| |
Collapse
|
10
|
Chalasani S, Benson KA. Lithium‐induced thyrotoxicosis in a patient with treatment‐resistant bipolar type I affective disorder. Med J Aust 2014; 201:541-2. [DOI: 10.5694/mja14.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
|
11
|
Kar N, Hullumane SR, Williams C. Thyrotoxicosis followed by hypothyroidism in a patient on lithium. Ment Illn 2014; 6:5415. [PMID: 25553233 PMCID: PMC4274457 DOI: 10.4081/mi.2014.5415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/11/2014] [Accepted: 05/20/2014] [Indexed: 11/23/2022] Open
Abstract
While hypothyroidism is common in lithium-treated patients, thyrotoxicosis is rarely reported. We present a female patient on lithium for maintenance therapy of bipolar affective disorder, who developed thyrotoxicosis for few months which was followed by hypothyroidism which continued. There was no further thyrotoxicosis episode during a five year follow up period. While she was treated for thyroid dysfunction, lithium was continued. There was no clinical impact on the maintenance of the bipolar affective disorder during the follow up period; she was maintained well in the community.
Collapse
Affiliation(s)
- Nilamadhab Kar
- Department of Psychiatry, Black Country Partnership NHS Foundation Trust, Wolverhampton, UK
| | | | | |
Collapse
|
12
|
Law A, Rifkind J, Rosen F, Lipton JH. Hyperthyroidism Six Years Post-BMT for Acute Myeloblastic Leukemia in a Patient on Long-Term Lithium Therapy for Bipolar Affective Disorder. Leuk Lymphoma 2009; 45:807-9. [PMID: 15160960 DOI: 10.1080/10428190310001617286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Lithium is commonly used to treat bipolar affective disorder. It is well known to adversely affect thyroid function, most commonly causing hypothyroidism. Hyperthyroidism is a rare complication. Similarly, total body irradiation (TBI) associated with BMT is well known to affect thyroid function frequently causing hypothyroidism. Hyperthyroidism secondary to TBI is unusual. To have both a history of chronic lithium therapy and TBI with a BMT in patient presenting with hyperthyroidism is an extremely atypical situation. We describe a 39-year-old male who presented with primary hyperthyroidism after 18 years of lithium use for bipolar affective disorder and 6 years post-BMT for AML-M4.
Collapse
Affiliation(s)
- Angeline Law
- Division of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, ON, Canada
| | | | | | | |
Collapse
|
13
|
Recognizing thyrotoxicosis in a patient with bipolar mania: a case report. Ann Gen Psychiatry 2008; 7:3. [PMID: 18284661 PMCID: PMC2270822 DOI: 10.1186/1744-859x-7-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 02/19/2008] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A thyroid stimulating hormone level is commonly measured in patients presenting with symptoms of mania in order to rule out an underlying general medical condition such as hyperthyroidism or thyrotoxicosis. Indeed, many cases have been reported in which a patient is initially treated for bipolar mania, but is later found to have a thyroid condition. Several case reports have noted the development of a thyroid condition in bipolar patients either on lithium maintenance treatment or recently on lithium treatment. CASE PRESENTATION We review a case in which a patient with a long history of bipolar disorder presents with comorbid hyperthyroidism and bipolar mania after recent discontinuation of lithium treatment. CONCLUSION Physicians should consider a comorbid hyperthyroidism in bipolar manic patients only partially responsive to standard care treatment with a mood stabilizer and antipsychotic.
Collapse
|
14
|
Kirov G, Tredget J, John R, Owen MJ, Lazarus JH. A cross-sectional and a prospective study of thyroid disorders in lithium-treated patients. J Affect Disord 2005; 87:313-7. [PMID: 16051025 DOI: 10.1016/j.jad.2005.03.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2005] [Revised: 03/21/2005] [Accepted: 03/22/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND The effects of lithium treatment on the thyroid gland have been demonstrated in a number of studies. Most of this research is based on cross-sectional studies and prospective studies are required to confirm these observations. METHOD During our genetic association studies, we recruited 115 males and 159 females suffering with affective disorders who had received lithium treatment. We observed longitudinally 57 of these patients, who attended our clinic for between 1 and 7 years and had no thyroid abnormalities at baseline. We performed regular checks of thyroid antibodies, thyroid function tests and lithium levels. RESULTS Hypo- and hyperthyroidism, including cases that developed prior to lithium treatment, were more common in women (25.8%) than in men (8.7%) and increased with age. By the age of 65, the risk in women increased to 50%. Hypothyroidism was induced by lithium in 17% women. In the prospective study, 4 out of 33 women developed hypothyroidism (an incidence of 27.4 cases per 1000 years). One woman developed thyrotoxicosis. CONCLUSIONS The risk for hypothyroidism induced by lithium is especially increased in women over the age of 50. Women should be warned of the risks involved when offered lithium treatment. The frequency of lithium-induced thyrotoxicosis is very low.
Collapse
Affiliation(s)
- George Kirov
- Department of Psychological Medicine, Cardiff University, Henry Wellcome Building, Heath Park, Cardiff CF14 4XN, Wales, UK.
| | | | | | | | | |
Collapse
|
15
|
Carmaciu CD, Anderson CS, Lawton CA. Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder. Bipolar Disord 2003; 5:381-4. [PMID: 14525561 DOI: 10.1034/j.1399-5618.2003.00052.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To highlight and discuss thyrotoxicosis after lithium withdrawal as a potential complication of lithium therapy for bipolar disorder. CASE REPORTS Both patients presented developed thyrotoxicosis, the first patient after stopping the lithium completely, and the second patient after a reduction in the lithium dose. CONCLUSIONS Clinicians should be alert to the possibility of thyrotoxicosis emerging when lithium is being completely or partially withdrawn. Such withdrawal could unmask a latent hyperthyroidism.
Collapse
Affiliation(s)
- C D Carmaciu
- Mental Health Department, Clacton and District Hospital, Clacton on Sea, Essex, UK.
| | | | | |
Collapse
|
16
|
Abstract
OBJECTIVE To report an unusual case of thyrotoxicosis caused by "silent thyroiditis" in a lithium-treated patient and to summarize all prior case reports of lithium-associated thyroiditis and compare them with our current case. METHODS In addition to reporting our case, we undertook a MEDLINE search of all case reports of lithium-associated thyroiditis from 1978 until the present. All reported cases of lithium-associated thyroiditis must have had documented low thyroid radioiodine uptake to be included. RESULTS A 52-year-old man with a history of bipolar disorder, who had been treated with lithium carbonate for 15 years, was admitted because of delusional mania. Although he had discontinued his lithium therapy 3 months before admission, he had noted symptoms of hyperthyroidism at least 1 month before admission. He was diagnosed with thyrotoxicosis due to silent thyroiditis on the basis of a high free thyroxine level, suppressed thyrotropin level, and low thyroid radioiodine uptake. We found only 10 other case reports of lithium-associated thyrotoxicosis due to silent thyroiditis. CONCLUSION Thyrotoxicosis caused by silent thyroiditis may be associated with lithium therapy and is likely to be underreported. The pathogenic mechanism for such cases of thyroiditis is still unclear.
Collapse
Affiliation(s)
- Andy H Dang
- Endocrinology and Metabolism Division, Department of Medicine, VA Greater Los Angeles Healthcare System and UCLA School of Medicine, Los Angeles, California 90073, USA
| | | |
Collapse
|
17
|
Abstract
OBJECTIVE To determine the incidence of silent thyroiditis in lithium users and characterize lithium-associated thyrotoxicosis. DESIGN Retrospective record review. PATIENTS 400 consecutive patients (300 with Graves' disease and 100 with silent thyroiditis) who underwent radioiodine scanning of the thyroid. MEASUREMENTS Odds of lithium exposure. RESULTS The odds of lithium exposure were increased 4.7-fold in patients with silent thyroiditis compared with those with Graves' disease (95% CI: 1.3, 17). Lithium-associated silent thyroiditis occurred with an incidence rate of approximately 1.3 cases per 1000 person-years, and lithium-associated thyrotoxicosis occurred with an incidence rate of approximately 2.7 cases per 1000 person-years, higher than the reported incidence rates of silent thyroiditis (< 0.03-0.28 cases per 1000 person-years) and of thyrotoxicosis (0.8-1.2 cases per 1000 person-years) in the general population. CONCLUSION Thyrotoxicosis caused by silent thyroiditis might be associated with lithium use.
Collapse
Affiliation(s)
- K K Miller
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | |
Collapse
|
18
|
Tasevski V, Benn D, King M, Luttrell B, Simpson A. Mitogenic effect of lithium in FRTL-5 cells can be reversed by blocking de novo cholesterol synthesis and subsequent signal transduction. Thyroid 2000; 10:305-11. [PMID: 10807058 DOI: 10.1089/thy.2000.10.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Lithium therapy is the therapeutic mainstay for bipolar disorder and has been associated in the thyroid with euthymic goiter, hyper and hypothyroidism as well as thyroid autoimmune disease. The FRTL-5 cell line is a well known model of thyroid cell physiology, where lithium has been shown to increase 3H-thymidine uptake at concentrations of 2 mM. This mitogenic effect was not associated with adenylate cyclase as measured by cyclic adenosine monophosphate (cAMP) production. The de novo synthesis of cholesterol is an important signal transduction pathway in FRTL-5 cells, where newly synthesized Rho GTPase is geranylgeranylated, enabling membrane localization of the G-protein and subsequent G1 to S-phase transition, resulting from extracellular stimulation. Here we confirm lithium mitogenicity at therapeutically relevant concentrations (1 mM) and demonstrate a lithium-associated accumulation of FRTL-5 cells in S-phase of the cell cycle. These effects could be abolished by Pravastatin, a potent inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA), the rate-limiting enzyme in the formation of intermediates (de novo cholesterol synthesis) required for G-protein prenylation. Pravastatin, similar to lithium, showed no effect on cAMP production either under basal or thyroid stimulating hormone (TSH)-stimulated conditions indicating that de novo cholesterol synthesis is not involved with adenylate cyclase. The inhibitory effect of pravastatin could be overcome by reinitiating de novo cholesterol synthesis. This was achieved by the addition of the cell permeable, first metabolite (mevalonate) after HMG-CoA, which allowed the cycle to continue, leading eventually to protein prenylation, despite the presence of Pravastatin. These novel findings demonstrate lithium involvement in de novo cholesterol synthesis and G-protein prenylation, an important signal transduction pathway in FRTL-5 cells.
Collapse
Affiliation(s)
- V Tasevski
- Department of Endocrinology, Royal North Shore Hospital, St. Leonards, NSW, Australia.
| | | | | | | | | |
Collapse
|
19
|
Panza N, Biondi B, Carella C, Lombardi G. About thyroxine administration during lithium therapy. J Endocrinol Invest 1999; 22:820-1. [PMID: 10614535 DOI: 10.1007/bf03343651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Abstract
BACKGROUND Little is known about the rate of thyroid disorders prior to lithium treatment, and which patients have a higher risk for developing such disorders during such treatment. METHOD Assessment of the thyroid histories and laboratory results of 209 lithium-treated patients with affective disorders from one catchment area. RESULTS Six female patients had thyrotoxicosis before starting lithium, a rate of 4.9%. Twenty patients developed hypothyroidism during the treatment: 3.4% of all males and 14.9% of all females. Female patients over the age of 50 were more likely to develop early lithium-induced hypothyroidism. CONCLUSIONS (1) Female patients with affective disorders might have an increased rate of thyrotoxicosis. (2) Lithium-induced hypothyroidism might develop earlier in female patients over the age of 50. LIMITATIONS Retrospective design of the study. CLINICAL RELEVANCE (1) The thyroid status of patients with affective disorders might be more relevant than is appreciated. (2) Guidelines for thyroid tests in lithium-treated patients should reflect the different risks conferred by age and gender.
Collapse
Affiliation(s)
- G Kirov
- Division of Psychological Medicine, Heath Park, Cardiff, UK.
| |
Collapse
|
21
|
Shimizu M, Hirokawa M, Manabe T, Shimozuma K, Sonoo H, Harada T. Lithium associated autoimmune thyroiditis. J Clin Pathol 1997; 50:172-4. [PMID: 9155705 PMCID: PMC499749 DOI: 10.1136/jcp.50.2.172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of autoimmune thyroiditis after long term treatment with lithium is described in a 29 year old Japanese woman with manic depression. Positive serum antithyroglobulin and antimicrosomal antibodies, diffuse goitre, and microscopic chronic thyroiditis, as well as the clinical history of long term lithium treatment were suggestive of lithium associated autoimmune thyroiditis. Microscopically, there was a mild degree of interstitial fibrosis and a moderate degree of lymphocytic infiltration. Some areas showed a moderate degree of stromal fibrosis and atrophic thyroid follicles. Lymphoid follicles with germinal centres, disrupted thyroid follicles with lymphocytic infiltration, and Hürthle cells were also observed. The differential diagnosis in patients presenting with these histological features includes painless (silent) thyroiditis, autoimmune thyroiditis and lithium associated autoimmune thyroiditis. A detailed clinical history is essential if the correct diagnosis is to be reached.
Collapse
Affiliation(s)
- M Shimizu
- Department of Pathology, Kawasaki Medical School, Okayama, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Bipolar affective disorder and autoimmune disease. Ir J Psychol Med 1996. [DOI: 10.1017/s0790966700002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIn Bipolar affective disorder, the importance of genetic factors is well established through family, twin and adoption studies. However the exact mode of inheritance is not yet known. Genetic studies using DNA linkage have been attempted to identify susceptibility genes. Linkage studies of chromosome 11 and X chromosome have proved to be inconclusive. Recent studies have focused on chromosome 18 and 21, although confirmatory findings are awaited. As such, determining which part of the genome needs to be studied remains a problem. One way of overcoming this is to look for ‘candidate’ genes, ie. genes for which a priori evidence exists that a susceptibility gene may be located nearby.Such strategies have been used for example, trying to identify genes of interest by looking at association between chromosomal aberrations and bipolar affective disorder, and the study of co-segregation of certain diseases with affective disorder. More studies are needed to provide regions of interest. I would like to report three cases of bipolar affective disorder with a rare autoimmune disorder, cryptogenic fibrosing alveolitis.
Collapse
|
23
|
Abstract
A 59 year-old manic-depressive woman treated with lithium for 10 years, developed hyperthyroidism three months after lithium withdrawal. The usual side effects on lithium on thyroid function include hypothyroidism and/or development of a goiter. Hyperthyroïdism occurring during lithium therapy is more rarely described. Hyperthyroidism has been exceptionally reported after lithium withdrawal, as in this case (five cases are recorded). The role of lithium in this pathology is controversial. Well-designed prospective studies are needed to clarify this question. Nevertheless, the effects of lithium on the thyroid metabolism are not always harmless and must prompt the clinicians to control the thyroid hormones before, during and after lithium therapy.
Collapse
Affiliation(s)
- E Weber
- Département de médecine interne, cliniques universitaires Saint-Luc-UCL, Bruxelles, Belgique
| | | |
Collapse
|
24
|
Barclay ML, Brownlie BE, Turner JG, Wells JE. Lithium associated thyrotoxicosis: a report of 14 cases, with statistical analysis of incidence. Clin Endocrinol (Oxf) 1994; 40:759-64. [PMID: 8033366 DOI: 10.1111/j.1365-2265.1994.tb02509.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Lithium is known to cause goitre and hypothyroidism, and has been associated less commonly with hyperthyroidism. We report a series of 14 patients with lithium associated thyrotoxicosis (LiAT), and have used epidemiological data to assess the association between long-term lithium treatment and the development of thyrotoxicosis. DESIGN Information for this retrospective study was obtained from records of patients attending the thyroid clinic between 1973 and 1991. Statistical analysis of the association between long-term lithium treatment and incidence of thyrotoxicosis was made using local thyrotoxicosis incidence figures and lithium prescription data. MEASUREMENTS Investigations included 99mTc pertechnetate thyroid scans, and blood analyses to measure serum T4, serum T3, free T4 index, and thyroid microsomal and thyroglobulin antibody titres. RESULTS During the 18-year period there were 14 patients with LiAT. This number of cases of thyrotoxicosis occurring in patients on lithium was more than three times greater than that predicted from local thyrotoxicosis incidence rates (P < 0.05). Scintiscans were obtained for 13 patients: 8 had toxic diffuse goitre, 2 toxic multinodular goitre, 1 toxic uninodular goitre, and 2 had a lack of visualization consistent with 'painless thyroiditis'. Nine patients received a course of carbimazole and 6 of these remain in remission. Six patients have received 131I therapy. Eight patients have become hypothyroid at follow-up (5 post 131I, 1 following a course of carbimazole, and the 2 with 'painless thyroiditis'). CONCLUSIONS Statistical analysis has shown that long-term lithium therapy is associated with an increased risk of thyrotoxicosis. LiAT is a heterogeneous condition with differing underlying thyroid pathologies and the mechanisms remain uncertain. The management of LiAT should initially be with antithyroid medication, and 131I therapy should be given only to patients who do not obtain long-term remission.
Collapse
Affiliation(s)
- M L Barclay
- Department of Nuclear Medicine, Christchurch Hospital, New Zealand
| | | | | | | |
Collapse
|
25
|
Persad E, Forbath N, Merskey H. Hyperthyroidism after treatment with lithium. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1993; 38:599-602. [PMID: 8306232 DOI: 10.1177/070674379303800906] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The association between treatment with lithium and hypothyroidism is well documented. Reports of hyperthyroidism are rare and it is less well known among patients treated with lithium. It may be overlooked simply because the clinician will be watching for hypothyroidism, the reverse phenomenon. This paper describes the cases of four patients who have been on long term lithium treatment, all of whom developed Graves' disease, or an atypical form of hyperthyroidism. Some suggestions are offered to account for the mechanism underlying this unusual association. Although hyperthyroidism may be rare among patients receiving lithium, astute clinical observation and appropriate laboratory tests are called for to detect the early stages of such thyroid dysfunction and to provide appropriate intervention.
Collapse
Affiliation(s)
- E Persad
- London Psychiatric Hospital, Ontario
| | | | | |
Collapse
|
26
|
Chow CC, Lee S, Shek CC, Wing YK, Ahuja A, Cockram CS. Lithium-associated transient thyrotoxicosis in 4 Chinese women with autoimmune thyroiditis. Aust N Z J Psychiatry 1993; 27:246-53. [PMID: 8363533 DOI: 10.1080/00048679309075773] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Four Chinese female patients who suffered from manic-depressive disorder and underlying autoimmune thyroiditis developed transient episodes of thyrotoxicosis during maintenance lithium therapy. Endocrinologically speaking, three of them had "Hashitoxicosis", while the other had silent lymphocytic thyroiditis. Albeit rare among Western patients, such lithium-associated thyroid dysfunctions appeared to be more likely to occur in Hong Kong Chinese. They seemed to involve multiple aetiological factors, such as autoimmune thyroid disease, the toxic and immunomodulatory roles of lithium and perhaps genetic and dietary factors. Because of their self-limiting nature, the importance of avoiding unnecessary and potentially deleterious antithyroid treatment is emphasised.
Collapse
Affiliation(s)
- C C Chow
- Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT
| | | | | | | | | | | |
Collapse
|
27
|
Lombardi G, Panza N, Biondi B, Di Lorenzo L, Lupoli G, Muscettola G, Carella C, Bellastella A. Effects of lithium treatment on hypothalamic-pituitary-thyroid axis: a longitudinal study. J Endocrinol Invest 1993; 16:259-63. [PMID: 8514981 DOI: 10.1007/bf03348825] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Lithium carbonate, widely used in the treatment of bipolar patients, is well known to induce thyroid alterations. In this longitudinal study the thyroid function was investigated during lithium treatment over a period of 12 months in 12 euthymic bipolar patients with a normal thyroid function and absence of thyroid antibodies. Nine of the 12 patients were further studied on the 15th month, 5 of these 9 on the 18th month and 4 of the last-mentioned 5 on the 24th month. The mean basal and TRH-stimulated TSH values during lithium therapy were significantly higher as compared to those at the beginning of the treatment. More particularly, during lithium therapy, a significant increase of basal TSH over the normal range was found in 10 out of the 12 patients. A rise of TRH-stimulated TSH was found in 11 out of the 12 patients. The impairment of the hypothalamic-pituitary-thyroid (HPT) axis was transitory in the majority of cases. Two patients developed a nodular goiter during the treatment. Plasma T3, T4, FT3 and FT4 levels did not change during the treatment. Thyroid antibodies remained undetectable. The conclusions of the study are twofold: 1) Subclinical hypothyroidism during lithium therapy is much more frequent than previous cross-sectional studies suggest; 2) Thyroxine replacement in lithium-treated patients is advisable in order to prevent subclinical hypothyroidism and the risk of a subsequent goiter.
Collapse
Affiliation(s)
- G Lombardi
- Dipartimento di Endocrinologia, Università di Napoli, Italy
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Lee S, Chow CC, Wing YK, Shek CC. Thyroid abnormalities during chronic lithium treatment in Hong Kong Chinese: a controlled study. J Affect Disord 1992; 26:173-8. [PMID: 1460167 DOI: 10.1016/0165-0327(92)90013-v] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Fifty Chinese psychiatric patients on chronic lithium treatment and the same number of sex- and age-matched control outpatients were assessed by a thyroidologist and underwent laboratory investigations. Lithium patients had a higher rate of goitres (50% vs 10%, P < 0.0001) and a higher mean TSH level (P < 0.005) than controls. Thyroid antibodies were detected in 7 older manic-depressive patients as opposed to 1 control, but not in patients with recurrent unipolar mania. Five patients, but no controls, had single or multiple episodes of hyperthyroidism, which was followed in 2 of them by biochemical hypothyroidism. It is suggested that variations in iodine status, dietary goitrogens, immunogenetic makeup and their complex interactions with chronic lithium treatment may contribute to ethnically different patterns of thyroid abnormalities.
Collapse
Affiliation(s)
- S Lee
- Department of Psychiatry, Chinese University of Hong Kong, Shatin
| | | | | | | |
Collapse
|
29
|
Sinnott MJ, McIntyre HD, Pond SM. Granulomatous thyroiditis and lithium therapy. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1992; 22:84. [PMID: 1580870 DOI: 10.1111/j.1445-5994.1992.tb01716.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
30
|
|
31
|
|
32
|
Arlot S, Madec AM, Mesmacque A, Debussche X, Lalau JD, Quichaud J. [Hyperthyroidism and treatment with lithium]. Rev Med Interne 1987; 8:303-4. [PMID: 3616236 DOI: 10.1016/s0248-8663(87)80234-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|