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 Posted - 06/13/2005 : 22:29:36
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Dear Members,
When you are on lithium, it is essential that every 3 months your doctor takes a blood test to check the following:
- Serum lithium level (taken exactly 12 hours after your last dose of lithium).
- Serum creatinine level (to measure your kidney functioning; since lithium is solely excreted out of your body by your kidneys).
- Serum thyroid stimulating hormone (TSH) level (to measure your thyroid functioning, since lithium can impair thyroid functioning in up to 17% of patients).
Approximately 12% of patients on lithium develop hypothyroidism, and up to 5% develop hyperthyroidism.
Usually lithium-induced hypothyroidism is easily treated and doesn't require termination of lithium therapy. Lithium-induced hyperthyroidism is also easily treated, but usually requires termination of lithium therapy.
Do Thyroid Disorders Cause Bipolar Disorder?
It should be remembered that both thyroid disorders and Bipolar Disorder are common illnesses; hence, by chance alone there will be some individuals that have both. Thus, the chance occurrence of both a thyroid disorder and Bipolar Disorder in the same person doesn't necessarily support the argument that "thyroid disorders cause Bipolar Disorder".
In fact, the vast majority of individuals with Bipolar Disorder (off lithium therapy) have normal thyroid functioning.
What is proven is the fact that lithium therapy carries a significant risk of causing hypothyroidism or hyperthyroidism.
Are Thyroid Disorders Frequently Misdiagnosed As Bipolar Disorder?
Hypo- and hyperthyroidism cause abnormal thyroid functioning tests; whereas Bipolar Disorder does not. Thus these lab tests quickly differentiate thyroid disorders from Bipolar Disorder.
In addition, the symptoms of hyperthyroidism are very different from Bipolar Disorder (ref: symptoms of hyperthyroidism at http://www.nlm.nih.gov/medlineplus/ency/article/000356.htm#Symptoms) (ref: symptoms of Bipolar Disorder at http://www.mentalhealth.com/dis1/p21-md02.html). Thus it would be highly unlikely that a physician would misdiagnose hyperthyroidism as a manic phase of Bipolar Disorder.
On the other hand, hypothyroidism shares many symptoms with the depressive phase of Bipolar Disorder (ref: http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm), hence it is essential that hypothyroidism be ruled out (with a thyroid function test) in every individual presenting with depression.
The following research documents lithium-induced disorders of thyroid functioning:
Adv Ther. 2002 Jul-Aug;19(4):176-84. Related Articles, Links
Thyroid abnormalities in lithium-treated patients.
Ozpoyraz N, Tamam L, Kulan E.
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 lithium-related 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 naive 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.
PMID: 12431043
J Int Med Res. 2002 Jan-Feb;30(1):80-4.
Thyroid abnormalities in lithium-treated patients with bipolar affective disorder.
Caykoylu A, Capoglu I, Unuvar N, Erdem F, Cetinkaya R.
The thyroid functions of 42 subjects with bipolar affective disorder receiving regular lithium therapy were analysed and their thyroid glands were examined by ultrasonography. Following the receipt of lithium therapy (duration 4-156 months), three subjects displayed subclinical hypothyroidism (7.1%), three subclinical hyperthyroidism (7.1%) and one hyperthyroidism (2.4%). Moreover, goitre was detected in 16 (38.1%) subjects. An increase in the conversion of free thyroxine (T4) to free tri-iodothyrosine (T3), which is an indication of mild thyroid dysfunction, was identified in 20 (47.6%) subjects, and was mostly seen in male subjects under 40 years of age and in those having weight gain. In conclusion, some thyroid dysfunctions were observed in the patients treated with lithium.
PMID: 11921503
Acta Psychiatr Scand. 2001 Jul;104(1):72-3; discussion 74-5.
Late-onset bipolar disorder due to hyperthyroidism.
Nath J, Sagar R.
OBJECTIVE: Bipolar disorder starts typically in early age and late-onset cases are rare. Late-onset cases are more likely to have comorbid medical illnesses responsible for them. This case report highlights late-onset bipolar disorder due to hyperthyroidism. METHOD: A 65-year-old patient of bipolar disorder has been described. RESULT: Physical examination and laboratory investigations detected presence of hyperthyroidism and the patient was treated with antithyroid and anxiolytics. CONCLUSION: A thorough examination and investigation are required in late-onset cases of bipolar disorder to rule out secondary causes. Definitive antimanic agents or mood stabilizers may not be required in such cases.
PMID: 11437754
Can J Psychiatry. 1993 Nov;38(9):599-602. Related Articles, Links
Hyperthyroidism after treatment with lithium.
Persad E, Forbath N, Merskey H.
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.
PMID: 8306232
Psychiatr Prax. 1993 Mar;20(2):74-7. Related Articles, Links
Lithium and hyperthyroidism
Brogmus KE, Winiarski B.
The development of hypothyroidism and the forming of a goiter are well-known complications associated with lithium medications. But there are also occasional references to cases of hyperthyroidism in the wake of both continual and of discontinued lithium medication. In the case being reported on here of a lady patient aged 64 and suffering from a toxic adenoma not recognized at the time, thyrotoxicosis accompanied by above-normal FT-3 results and the characteristic clinical symptoms developed when lithium medication was discontinued. Medical literature consulted in the context discussed pharmacological mechanisms which may be responsible for the said complications.
PMID: 8367545
J Affect Disord. 1992 Nov;26(3):173-8.
Thyroid abnormalities during chronic lithium treatment in Hong Kong Chinese: a controlled study.
Lee S, Chow CC, Wing YK, Shek CC.
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.
PMID: 1460167
J Clin Psychiatry. 1987 Jul;48(7):289-90.
The problem with parsimony: mania and hyperthyroidism.
Walter-Ryan WG, Fahs JJ.
A patient is described who developed mania during an episode of hyperthyroidism and later presented again with mania following correction of the thyroid disturbance. Although there are prominent connections between endocrine and mood disorders, clinicians are advised to recall basic medical principles and not assume that an etiological relationship exists in the individual patient until it is proven.
PMID: 3597331
Acta Med Scand. 1978;204(1-2):141-3.
Thyrotoxicosis in a patient treated with lithium carbonate for mental disease.
Pallisgaard G, Frederiksen K.
In recent years a few cases of hyperthyroidism and several of hypothyroidism which developed during lithium therapy have been described. We give an account of a case of hyperthyroidism, due to painless thyroiditis in a patient on long-term lithium therapy.
PMID: 685723
Phil Long M.D.
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Common Thyroid Complications Caused By Lithium
