Abstract
In the present cross-sectional study, thyroid functions (viz. thyroid radioiodine uptake [RAIU] and serum T3, T4, and thyroidstimulating hormone [TSH]) were evaluated in 24 healthy controls and 132 outdoor affective disorder patients. Eleven of these patients were to receive lithium (Li) and the remaining 121 patients were at different stages of Li treatment ranging from 0.7 to 240 mo. RAIU was found to increase significantly throughout the Li therapy and was associated with the corresponding rise in TSH levels. In totality, Li treatment induced subclinical hypothyroidism in 51/132 (39%) of patients. However, 8/51 patients who belonged to known iodine-deficient belt had abnormally high TSH (range 15.2–76.0 uIU/mL), low T4 (5.3 ± 2.5 Hg/dL), and normal T3 and at least 4 of these 8 patients were clinically hypothyroid. T4 levels declined significantly (p < 0.05) with Li treatment ranging from 61 to 240 mo as compared to the corresponding values in the pre-Li group. The T3/T4 ratio was found to be significantly higher with Li treatment ranging from 0.7 to 6 mo in comparison with the pre-Li group and this value returned to base levels after long-term Li therapy. High T3 and T4 were observed in 13% and 12% of the patients, respectively, as compared to the corresponding control values.
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References
B. M. Wagner, T. B. Copper, and N. S. Klin, Structural basis of lithium,Int. Pharmacopsychiatr.5, 208–218 (1970).
F. A. Freyhan, R. A. O’Connell, and J. A. Mayo, Treatment of mood disorders with lithium carbonate,Int. Pharmacopsychiatr.5, 137–148 (1970).
J. W. Jefferson, Lithium: The present and the future,J. Clin. Psychiatry 51(8), 4–8 (1990).
G. Kallner and U. Petterson, Renal, thyroid and parathyroid function during lithium treatment: Laboratory tests in 207 people treated for 1–30 years,Acta Psychiatr. Scand.91, 48–51 (1995).
M. Schou, A. Amdisen, S. E. Jensen, and T. Olsen, Occurrence of goitre during lithium treatment,Br. Med. J. 3, 710–713 (1968).
G. Sedvall, B. Jonsson, U. Petterson, and H. Levin, Effects of lithium salts on plasma protein bound iodine and uptake of radioiodine in thyroid gland of man and rat,Life Sci. 7, 1257–1264 (1968).
B. Shopsin, Effects of lithium on thyroid function—a review,Dis. Nerv. Syst. 31, 237–244 (1970).
G. Rogers, W. Burke, J. Himmelhoch, R. Spencer, and J. Hershman, Effect of lithium on thyroid function,J. Clin. Endocrinol.32, 647–652 (1971).
V. Lauridsen, C. Kirkegaard, and J. Nerup, Lithium and the pituitary-thyroid axis in normal subjects,J. Clin. Endocr. Metab. 39, 383–385 (1974).
C. Hoschl, Lithium influence on TSH response to TRH in depressed patients,Physicologia 30, 89–90 (1981).
K. Bakker, The influence of lithium carbonate on the hypothalamic-pituitary-thyroid axis,Agressologie 23, 89–93 (1982).
H. Perrilid, K. Madsen, and M. C. Hansen, Irreversible myxoedema after lithium carbonate,Br. Med. J. 76, 1108–1109. (1978).
S. Cairns, R. Wolman, and J. Lewis, persistent nephrogenic diabetes insipidus, hyperthyroidism and hypothyroidism after lithium treatment,Br. Med. J. 290, 516–517 (1985).
D. Myers D. R. Carter, B. Burns, A. Armond, S. Hussain, and V. Chengapa, A prospective study of the effects of lithium on thyroid function and on the prevalence of antithyroid antibodies,Psychol. Med. 15, 55–61 (1985).
R. Hullin, R. McDonald, and M. Allsopp, Further report on prophylactic lithium in recurrent affective disorders,Br. J. Psychiatry 126, 281–286 (1975).
J. Calabrese, D. Gulledge, K. Hahn, R. Skwerer, M. Kotz, O. Schumacher, et al., Autoimmune thyroiditis in manic depressive patients treated with lithium,Am. J. Psychiatry 142, 1318–1321 (1985).
M. Crowe, G. Lloyd, S. Bloch, and R. Rosser, Hypothyroidism in patients treated with lithium, a review and two case reports,Psychol. Med. 3, 337–342 (1973).
M. Schoenberg, T. Ts’o, and A. Meisel, Single case study—Grave’s disease manifesting after maintainence lithium,J. Clin. Psychiatry 167, 575–577 (1979).
P. Rabin and D. Evans, Exophthalmos and elevated tyroxine levels in association with lithium therapy,J. Clin. Psychiatry 42, 398–400 (1981).
J. P. Kushner and P. Vestergaard, Lithium-thyroid interactions, inLithium and the Endocrine System, F. N. Johnson, ed., Karger, Basel, pp. 74–93 (1988).
P. W. Brown and E. F. Legg, The estimation of lithium in serum,Ann. Clin. Biochem. 7, 13–17 (1970).
K. Maarbjerg, P. Vestergaard, and M. Scou, Changes in serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) during prolonged lithium treatment,Acta Psychiatr. Scand.75, 217–221 (1987).
I. Tansbol, C. Christiansen, and P. Baastrup, Endocrine effects of lithium: hypothyroidism, its prevalence in long term treated patients,Acta Endocr. Copenh. 87, 759–767 (1978).
J. Lazarus, R. John, E. Bennie, R. Chalmers, and G. Crockett, Lithium therapy and thyroid function—a long term study,Psychol. Med. 11, 85–92 (1981).
A. Amdisen and C. Anderson, Lithium treatment of thryoid function—a survey of 237 patients in long term lithium treatment,Pharmacopsychiatry 15, 149–155 (1982).
H. Perrilid, L. Hegedus, and K. Arnung, Sex related goitrogenic effect of lithiumcarbonate in healthy young subjects,Acta Endocr. Copenh. 106, 203–208 (1984).
J. J. W. Alastair, Drug therapy,New Eng. J. Med. 333(25), 1688–1694 (1995).
P. Rabin and D. Evans, Exophthalmos and elevated thyroxine levels in association with lithium therapy,J. Clin. Psychiatry 42, 398–400 (1981).
C. Goplan,Nutrition Problems in South-East Asia, SEARO Regional Health Papers WHO Publications15, World Health Organization, Geneva (1987).
A. Bocchetta, F. Bernardi, and M. Pedditzi, Thyroid abnormalities during lithium treatment,Acta Psychiatr. Scand.83, 193–198 (1991).
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Deodhar, S.D., Singh, B., Pathak, C.M. et al. Thyroid functions in lithium-treated psychiatric patients. Biol Trace Elem Res 67, 151–163 (1999). https://doi.org/10.1007/BF02784070
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DOI: https://doi.org/10.1007/BF02784070