Quetiapine-Associated Hypothyroidism in Young Female Patients: A Report of Three Cases

Poutanen, Outi; Iso-Koivisto, E.; Työläjärvi, Marja; Leìnonen, Esa

doi:10.1055/s-0030-1261880

Cited by 9 publications

(16 citation statements)

References 12 publications

(24 reference statements)

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“…Consistent with our findings, among atypical antipsychotics, evidence of increased hypothyroidism risk has also accumulated for quetiapine . However, not all studies agreed.…”

Section: Discussionsupporting

confidence: 82%

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

et al. 2016

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ObjectivesThyroid abnormalities in patients with bipolar disorder (BD) have been linked to lithium treatment for decades, yet other drugs have been less well studied. Our objective was to compare hypothyroidism risk for lithium versus the anticonvulsants and second‐generation antipsychotics commonly prescribed for BD.MethodsAdministrative claims data on 24,574 patients with BD were analyzed with competing risk survival analysis. Inclusion criteria were (i) one year of no prior hypothyroid diagnosis nor BD drug treatment, (ii) followed by at least one thyroid test during BD monotherapy on lithium carbonate, mood‐stabilizing anticonvulsants (lamotrigine, valproate, oxcarbazepine, or carbamazepine) or antipsychotics (aripiprazole, olanzapine, risperidone, or quetiapine). The outcome was cumulative incidence of hypothyroidism per drug, in the presence of the competing risk of ending monotherapy, adjusted for age, sex, physician visits, and thyroid tests.ResultsAdjusting for covariates, the four‐year cumulative risk of hypothyroidism for lithium (8.8%) was 1.39‐fold that of the lowest risk therapy, oxcarbazepine (6.3%). Lithium was non‐statistically significantly different from quetiapine. While lithium conferred a higher risk when compared to all other treatments combined as a group, hypothyroidism risk error bars overlapped for all drugs. Treatment (p = 3.86e‐3), age (p = 6.91e‐10), sex (p = 3.93e‐7), and thyroid testing (p = 2.79e‐87) affected risk. Patients taking lithium were tested for hypothyroidism 2.26–3.05 times more frequently than those on other treatments.ConclusionsThyroid abnormalities occur frequently in patients with BD regardless of treatment. Therefore, patients should be regularly tested for clinical or subclinical thyroid abnormalities on all therapies and treated as indicated to prevent adverse effects of hormone imbalances on mood.

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“…Consistent with our findings, among atypical antipsychotics, evidence of increased hypothyroidism risk has also accumulated for quetiapine . However, not all studies agreed.…”

Section: Discussionsupporting

confidence: 82%

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

et al. 2016

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“…Early studies have reported decreased TT3 and TT4, but not TSH, in patients receiving 6-week quetiapine treatment 14. A series of case reports also presented quetiapine-associated hypothyroidism 15–18. In a recent naturalistic study, lower FT4 was also associated with the use of antipsychotics (including quetiapine) 11.…”

Section: Discussionmentioning

confidence: 97%

<p>Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study</p>

Li¹,

Lai²,

Huang³

et al. 2019

NDT

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Objective Previous studies have demonstrated a potentially close relationship between mood disorders and thyroid abnormalities. The aims of this study are to investigate: 1) whether significant differences of thyroid profiles exist between manic and depressive episodes in patients with bipolar disorder (BD); 2) the impact of quetiapine monotherapy on thyroid functions in depressed BD patients. Methods In this retrospective naturalistic study, we reviewed patients’ information based on an electronic medical system from January 2015 to April 2019. Patients with a discharge diagnosis of BD, a current depressive or manic episode, were screened. All depressed BD patients were treated with quetiapine monotherapy for at least one month. For all patients enrolled, the demographic, clinical data and thyroid functions were recorded. The differences between thyroid profiles including total thyroxine (TT4), total triiodothyronine (TT3), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) between patients with different episodes were analyzed. In addition, the change of thyroid functions before and after one-month or three-month quetiapine treatment in depressed BD patients was also analyzed. Results Totally, 28 patients with a manic episode and 58 patients with a depressive episode were enrolled. No significant differences in thyroid profiles were found in patients with different mood episodes. After one-month quetiapine treatment, serum levels of TT4, FT4 and FT3 were significantly reduced ( P <0.05), TSH was increased ( P =0.015), while TT3 was not significantly changed ( P =0.425). After three-month quetiapine treatment, serum levels of TT4, TT3, FT4 and FT3 were significantly reduced ( P <0.05), except TSH ( P =0.990). Conclusion These findings indicate that thyroid functions were not significantly fluctuated between depressive and manic episodes in BD patients. Nonetheless, quetiapine treatment may disturb the thyroid system and needs close monitoring.

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“…The 11 case reports gave details on 15 patients (Table 1). [14][15][16][17][18][19][20][21][22][23][24] Quetiapine was used for a range of psychiatric diagnoses including bipolar disorder (BD; n = 5), schizoaffective disorder bipolar subtype (n = 4), and schizophrenia (n = 2). The majority of patients were women (n = 12) and were between 18 and 65 years of age (n = 10).…”

Section: Clinical and Sociodemographic Characteristicsmentioning

confidence: 99%

Quetiapine‐Induced Thyroid Dysfunction: A Systematic Review

Khoodoruth

Abdo

Ouanes

2021

The Journal of Clinical Pharma

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Thyroid abnormalities are documented consequences of quetiapine treatment. This may have clinical implications as changes in thyroid hormones may deteriorate a person's affective state. Yet less is known about the clinical factors and underlying mechanisms associated with thyroid hormones on quetiapine therapy. We therefore systematically reviewed the published literature of evidence of quetiapine-induced thyroid abnormalities. We searched MEDLINE, PsycINFO, Google Scholar, and EMBASE for articles in which individuals developed biochemically confirmed thyroid abnormalities (with or without clinical symptoms) while on quetiapine treatment. We included case reports, case series, observational, and experimental studies. We included 32 studies, 20 of which were observational and experimental studies. There were 10 case reports and 1 case series. All the research designs suggested an association between quetiapine and hypothyroidism. However, these findings were limited by the quality of the included studies and the general lack of either a clear temporal relationship or dose response. Quetiapine has been associated with thyroid abnormalities, mainly with hypothyroidism. Drug imputability in these abnormalities is not always clear, and the underlying pathophysiology may include immunological and nonimmunological mechanisms. Large prospective studies are required to clarify this association and to further inform the management of patients treated with quetiapine where hypothyroidism occurs.

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Quetiapine-Associated Hypothyroidism in Young Female Patients: A Report of Three Cases

Cited by 9 publications

References 12 publications

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort

<p>Thyroid functions in patients with bipolar disorder and the impact of quetiapine monotherapy: a retrospective, naturalistic study</p>

Quetiapine‐Induced Thyroid Dysfunction: A Systematic Review

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