Effects of maintenance lithium treatment on serum parathyroid hormone and calcium levels: a retrospective longitudinal naturalistic study

Abstract

ObjectiveThe aim of this retrospective longitudinal naturalistic study was to evaluate the effects of maintenance lithium treatment on parathyroid hormone (PTH) and calcium levels.MethodsA retrospective longitudinal naturalistic study design was used. Data were collected from the database of a tertiary psychiatric center covering the years 2010–2014. Included were bipolar patients who had never been exposed to lithium and had lithium started, and who had PTH, and total and ionized calcium levels available before and during lithium treatment. Paired t-tests were used to analyze changes in PTH and calcium levels. Linear regressions were performed, with mean lithium level and duration of lithium exposure as independent variables and change in PTH levels as dependent variable.ResultsA total 31 patients were included. The mean duration of lithium treatment was 18.6±11.4 months. PTH levels significantly increased during lithium treatment (+13.55±14.20 pg/mL); the rate of hyperparathyroidism was 12.9%. Neither total nor ionized calcium increased from baseline to follow-up; none of our patients developed hypercalcemia. Linear regressions analyses did not show an effect of duration of lithium exposure or mean lithium level on PTH levels.ConclusionLithium-associated stimulation of parathyroid function is more common than assumed to date. Among parameters to be evaluated prior to lithium implementation, calcium and PTH should be added.

Clinical Severity and Calcium Metabolism in Patients with Bipolar Disorder

“…Lastly, according to our regression model, higher levels of PTH are predicted by a pharmacological treatment with lithium. This result is in line with available studies, which have found that a long-term treatment with lithium stimulates the parathyroid function, leading to a secondary hyperparathyroidism [ 51 ]. Although the real prevalence of this phenomenon is unclear, about 25% of lithium-treated patients have disturbances in the calcium homeostasis [ 52 ].…”

Lithium side effects and toxicity: prevalence and management strategies

“…A meta-analysis of relevant studies found that lithium treatment was associated with a 10% increase in blood calcium and PTH levels (McKnight et al 2012). Studies published since then have mostly confirmed this finding (Albert et al 2013, 2015; Shine et al 2015). There is some evidence that lithium-associated hypercalcemia/hyperparathyroidism is associated with fewer clinical symptoms than are seen in primary hyperparathyroidism (Shapiro and Davis 2015).…”

The Effects of Lithium on Calcium and Parathormone Levels: A Cross-sectional Study with Healthy Controls

“…Sonraki yıllarda yapılan çalışmalarda lityum ile ilişkili hiperparatiroidiye (LİH) bağlı hiperkalseminin görülme sıklığı %3,6-62 gibi geniş bir aralıkta bulunmuştur (Albert ve ark. 2013, Albert ve ark. 2015, Awad ve ark.…”

“…Karaciğer, böbrek yetmezliği ve vitamin D yetersizliği sekonder hiperparatirodiye; sekonder hiperparatiroidi çok uzun süre devam ederse tersiyer hiperparatiroidiye neden olabilir. En sık tersiyer hiperparatiroidi nedenleri kronik böbrek hastalığı, uzun süreli yüksek fosfat düzeyi ve düşük 1,25-dihidroksi vitamin D düzeyi olmasına rağmen (Fraser 2009) vitamin D düzeyi sadece üç çalışmada değerlendirilmiştir (Albert ve ark. 2015, Meehan ve ark.…”

“…Çoğunlukla, Ca ya da PTH'nin tek bir yüksek düzeyi LİH olarak kabul edilmiştir. Bu şekilde değerlendirmenin yapıldığı yakın tarihli iki çalışmada hiperparatiroidi prevalansı %12,9 ve %22,8 bulunmuşken, hiperparatiroidi olarak değerlendirilenlerin Ca düzeylerinin normal sınırlar içinde yer alması LİH tanısı açısından düşündürücüdür (Albert ve ark. 2015, de Oliveira ve ark.…”