Histological features of the thyroid gland in a patient with lithium induced thyrotoxicosis.

Mizukami, Yuji; Michigishi, Takatoshi; Nonomura, Akitaka; Nakamura, Shinobu; Noguchi, M.; Takazakura, Eisuke

doi:10.1136/jcp.48.6.582

Cited by 42 publications

(28 citation statements)

References 11 publications

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“…Hyperthyroidism is rare in lithium-treated patients. In most cases, it occurs after many years of treatment (2,3,39). Consistent with the literature, among 84 patients, only 1 (1.2%) case of subclinical hyperthyroidism was found.…”

Section: Discussionsupporting

confidence: 77%

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls

Tunçel

Akdeniz

Özbek

et al. 2017

Arch Neuropsychiatr

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Introduction: Lithium has many effects on thyroid physiology. Although these side effects have been known for a long time, large sample studies of lithium-treated patients using ultrasonography are lacking. The aim of this study is to investigate the detailed thyroid morphologies, hormone levels, and antibodies of lithium-treated patients compared with healthy controls.Methods: This cross-sectional study involved 84 lithium-treated patients with bipolar disorder and 65 gender and age similar controls who had never been exposed to lithium. Subjects between 18 and 65 years of age were eligible for the study. Venous blood samples were acquired to determine the levels of free thyroxine (fT4), thyroid stimulating hormone (TSH), and thyroid antibodies; also, ultrasonographic examinations of the patients' thyroid glands were performed.Results: There were no statistically significant differences in smoking habits, known thyroid disease, thyroid medication use, familial thyroid disease, fT4 level, autoimmunity, thyroid nodule presence, or Hashimoto' s thyroiditis between the lithium and control groups. The median TSH level and thyroid volume were significantly higher in the lithium group. In the lithium group, 14 cases (16.7%) of hypothyroidism, seven cases (8.3%) of subclinical hypothyroidism, and one case (1.2%) of subclinical hyperthyroidism were defined; in the control group, seven cases (10.8%) of hypothyroidism and two cases (3.1%) of subclinical hyperthyroidism were defined. Thyroid dysfunction, goiter, parenchymal abnormality, ultrasonographically defined thyroid abnormality, and thyroid disorder were found to be more prevalent in the lithium group. 90% of patients with goiter and 74.3% of patients with ultrasonographic pathologies were euthyroid. Conclusion:It is important to note that 90% of the patients with goiter were euthyroid. This indicates that monitoring by blood test alone is insufficient. The prevalence rates of 47.6% for goiter and 83.3% for ultrasonographic pathology demonstrate that ultasonographic follow-up may be useful in lithium-treated patients. To determine whether routine ultrasonographic examination is necessary, large sample prospective studies are necessary due to the limitations of this study.

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Section: Discussionsupporting

confidence: 77%

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls

Tunçel

Akdeniz

Özbek

et al. 2017

Arch Neuropsychiatr

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“…Whilst psychiatrists prescribing lithium for bipolar affective disorder can expect the development of hypothyroidism in up to 30% of patients (5, 6), the emergence of thyrotoxicosis in relation to lithium treatment remains a paradoxical, rare and poorly explained phenomenon. Our literature search has yielded about 50 previously reported cases of lithium‐associated hyperthyroidism, some of these occurring on lithium withdrawal but none on dose reduction (3–16). Statistical analysis however has shown that long‐term lithium therapy is associated with an increased risk of thyrotoxicosis (4).…”

mentioning

confidence: 99%

“… an autoimmune thyroid disease triggered off by lithium (5–9, 16); disturbed iodine kinetics with escape phenomenon and ‘overflow’ of thyroid hormone after expansion of the intrathyroidal iodine pool (3, 4, 6, 12, 13); a Jod–Basedow‐like phenomenon (3); direct damage by lithium of thyroid follicular cells with subsequent release of thyroglobulin into the circulation (10, 14); coincidental Graves’ disease (16) or other coincidental hyperthyroidism. …”

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confidence: 99%

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Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder

2003

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Objectives: To highlight and discuss thyrotoxicosis after lithium withdrawal as a potential complication of lithium therapy for bipolar disorder. Case Reports: Both patients presented developed thyrotoxicosis, the first patient after stopping the lithium completely, and the second patient after a reduction in the lithium dose. Conclusions: Clinicians should be alert to the possibility of thyrotoxicosis emerging when lithium is being completely or partially withdrawn. Such withdrawal could unmask a latent hyperthyroidism.

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“…However, it has been reported that lithium may directly damage thyroid follicular cells, which is the cause of transient thyrotoxicosis in patients with lithium-induced painless thyroiditis 10) . Such follicular destruction has also been reported in amiodarone-induced thyrotoxicosis 11) .…”

Section: Discussionmentioning

confidence: 99%

A Case of Lithium-Associated Painless Thyroiditis

Fukazawa

Yoshida

2009

J Rural Med

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Lithium, prescribed for bipolar disorder, is known to induce thyroid dysfunction, most commonly hypothyroidism. Thyrotoxicosis due to lithium-induced painless thyroiditis is a rare complication. We have previously reported that the serum concentration of immunosuppressive acidic protein (IAP), an α1-acid glycoprotein, increased during the acute phase of subacute thyroiditis, but was within the normal range in patients with painless thyroiditis. In the present case, a 31-year-old woman, receiving long-term lithium therapy for bipolar disorder, had a recurrent episode of painless thyroiditis, and her serum IAP was increased. The pathogenic mechanism for lithium-associated painless thyroiditis may differ from that of autoimmune conditions.

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Histological features of the thyroid gland in a patient with lithium induced thyrotoxicosis.

Abstract: Angiitis por hipersensibilidad y hepatitis granulomatosa inducida por glibenclamida: a proposito de un caso. Med Clin (Barc) 1980;75:306-8.

Cited by 42 publications

References 11 publications

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls

Thyroid Function and Ultrasonography Abnormalities in Lithium-Treated Bipolar Patients: A Cross-sectional Study with Healthy Controls

Thyrotoxicosis after complete or partial lithium withdrawal in two patients with bipolar affective disorder

A Case of Lithium-Associated Painless Thyroiditis

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