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Lithium-associated clinical hypothyroidism: Prevalence and risk factors

  • Ann M. Johnston (a1) and John M. Eagles (a2)
Abstract
Background

Rates of, and risk factors for, lithium-associated clinical hypothyroidism are uncertain.

Aims

To determine prevalence of and risk factors for clinical hypothyroidism in patients treated with lithium carbonate.

Method

Retrospective case-note review of 718 patients who had undergone serum lithium estimation during a 15-month period. Patients on thyroxine had a more detailed review.

Results

The prevalence of clinical hypothyroidism during lithium treatment was 10.4%. The main risk factor was female gender (women 14% v. men 4.5%). Women were at highest risk during the first two years of lithium treatment, and women starting lithium aged 40–59 years had the greatest prevalence (> 20%). No equivalent risk factors emerged in men, although, like women, their prevalence of hypothyroidism was substantially higher than community rates.

Conclusions

The high rates of clinical hypothyroidism identified may call for a review of the drug information given to women, particularly to those starting lithium in middle age. Consideration should be given to screening for thyroid antibodies before treatment in high-risk cases. Monitoring of thyroid function should take into account gender, age and stage of lithium treatment.

Copyright
Corresponding author
Ann M. Johnston, Consultant Psychiatrist. Psychiatric Unit, Hairmyres Hospital, Eaglesham Road, East Kilbride, Lanarkshire G75 8RG
Footnotes
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Declaration of interest

None.

Footnotes
References
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Bland, J. M. & Altman, D. G. (1998) Survival probabilities (the Kaplan-Meier method). British Medical Journal, 317, 1572.
Bocchetta, A., Cherchi, A., Loveselli, A., et al (1996) Six-year follow-up of thyroid function during lithium treatment. Acta Psychiatrica Scandinavica, 94, 4548.
Calabrese, J. R., GuHedge, A. D., Hahn, K., et al (1985) Autoimmune thyroiditis in manic-depressive patients treated with lithium. American Journal of Psychiatry 142, 13181321.
Cowdry, R. W., Wehr, T. A. & Zis, A. P. (1983) Thyroid abnormalities associated with rapid-cycling bipolar illness. Archives of General Psychiatry, 40, 414420.
Ferrier, I. N., Tyrer, S. P. & Bell, A. J. (1995) Lithium therapy. Advances in Psychiatric Treatment, 1, 102110.
Goodwin, F. K. (1990) Effect of long-term lithium on organs and systems. In Manic Depressive Illness (eds Goodwin, F. K. & Jamison, K. R.), pp. 702704. New York: Oxford University Press.
Hickie, I., Bannett, B., Mitchell, P., et al (1996) Clinical and subclinical hypothyroidism in patients with chronic and treatment-resistant depression. Australian and New Zealand Journal of Psychiatry 30, 246252.
Jefferson, J. W. (1990) Lithium: the present and the future. Journal of Clinical Psychiatry, 51 (suppl. 8), 48.
Leibenluft, E. (1996) Women with bipolar illness: clinical and research issues. American Journal of Psychiatry 153, 163173.
Luby, E. D., Schwartz, D. & Rosenbaum, H. (1971) Lithium-carbonate-induced myxedema. Journal of the American Medical Association, 218, 12981299.
Maarbjerg, K., Vestergaard, P. & Schou, M. (1987) Changes in serum thyroid stimulating hormone (TSH) during prolonged lithium treatment. Acta Psychiatrica Scandinavica, 75, 217221.
Monzani, F., Pruneti, C. A., De Negri, F., et al (1991) Preclinical hypothyroidism: early involvement of memory function, behavioral responsiveness and myocardial contractility. Minerva Endocrinobgica, 16, 113118.
Schou, M., Amisden, A., Jensen, S. E., et al (1968) Occurrence at goitre during lithium treatment. British Medical Journal, iii, 710713.
Shelley, R. (1995) Affective disorders: 2. Lithium. In Seminars in Clinial Psychopharmacology (ed. King, D. J.), pp. 193223. London: Gaskell.
Tunbridge, W. M. G., Evered, D. C., Hall, R., et al (1977) The spectrum of thyroid disease in a community: the Whickham Survey. Clinical Endocrinology 7, 481493.
Vanderpump, M. P. J., Tunbridge, W. M. G., French, J. M., et al (1995) The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clinical Endocrinology 43, 5568.
Weetman, A. P. (1997) Hypothyroidism screening and subclinical disease. British Medical Journal, 314, 11751178.
Yassa, R., Saunders, A., Nastase, C., et al (1988) Lithium-induced thyroid disorders: a prevalence study. Journal of Clinical Psychiatry, 49, 1416.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Lithium-associated clinical hypothyroidism: Prevalence and risk factors

  • Ann M. Johnston (a1) and John M. Eagles (a2)
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