Abstract
BackgroundLithium was known to cause thyroid dysfunction and most commonly subclinical hypothyroidism (SCH). The aim of this study is to determine the prevalence of Lithium associated thyroid dysfunction and to identify risk factors associated with development of SCH in patients receiving Lithium.MethodsA retrospective cross-sectional study was conducted. Subjects who developed elated thyroid stimulating hormone (TSH) were compared with those who remained euthyroid with Lithium treatment. Logistic regression and survival analysis were applied to identify the significant factors associated with SCH.ResultsThe prevalence of Lithium associated with SCH was 31.7 %. The significant risk factors associated with increased risk of SCH included being female, higher serum Lithium level, concomitant use of Valproate Sodium and use of antidepressant. Use of depot injection was associated with decreased risk of SCH.ConclusionsUse of depot and avoidance of Valproate or antidepressant should be taken into account before starting patient on Lithium treatment. Thyroxine replacement should be considered when Lithium associated SCH was identified.
Highlights
Lithium was known to cause thyroid dysfunction and most commonly subclinical hypothyroidism (SCH)
Total 304 cases that were on Lithium treatment at Pamela Youde Nethersole Eastern Hospital (PYNEH) on 1st March 2014 were indentified through CDARS
thyroid stimulating hormone (TSH) of the remaining 169 (64.5 %) patients remained non-elated while on Lithium treatment. 10 (3.8 %) patients developed decreased TSH, of whom 1 (0.4 %) case developed clinical hyperthyroidism and 9 (3.4 %) cases developed subclinical hyperthyroidism. 159 (60.7 %) patients remained euthyroid throughout the study
Summary
Lithium was known to cause thyroid dysfunction and most commonly subclinical hypothyroidism (SCH). Throughout years of research since its introduction, Lithium has been well established as an effective agent for treatment in acute mania, prophylaxis of bipolar disorder and augmentation in refractory depression. Among the possible side effects of Lithium, thyroid dysfunction especially subclinical hypothyroidism (SCH) was a common yet often neglected one. Lithium was reported to concentrate in thyroid gland and inhibit thyroidal iodine uptake. It inhibits iodotyrosine coupling, alters thyroglobulin structure and inhibits thyroid hormone secretion. Lithium inhibits synthesis and release of thyroid hormones by stabilizing effect on thyroid microtubules, decreasing adenylate cyclase responsiveness to TSH and suppressing cyclic adenosine mono phosphate (c-AMP)
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