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A prospective study of the effects of lithium on thyroid function and on the prevalence of antithyroid antibodies

  • D. H. Myers (a1), R. A. Carter (a1), B. H. Burns (a1), A. Armond (a1), S. B. Hussain (a1) and Vinnie K. Chengapa (a1)
  • DOI:
  • Published online: 01 July 2009

Tests of thyroid function and pathology were carried out on 133 patients before they were treated with lithium (Li+). Of the 12 patients who subsequently became hypothyroid during treatment with lithium 9 had, before the commencement of treatment, thyroid autoantibodies and/or an exaggerated thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH), whereas 3 patients had neither of these indicators. Lithium administration was accompanied by a rise in thyroid antibody titre in 20 patients but a fall in only 5, a statistically significant difference. Evidence that it may be an immunostimulant is discussed. Li+-induced thyroid failure cannot be accurately predicted, and may occur suddenly. The best minimum safeguard, therefore, is serial thyroxine (T4) (or free T4) estimation, supplemented if equivocal by a free thyroxine index (FTI), a basal TSH and, if doubt remains, by a TRH test.

Corresponding author
1 Address for correspondence: Dr D. H. Myers, Royal Shrewsbury Hospital, Shelton, Shrewsbury SY3 8DN.
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