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Hypothyroidism in patients with Bipolar I Disorder treated primarily with lithium

Published online by Cambridge University Press:  18 May 2011

Andrea Fagiolini ,
David J. Kupfer ,
John Scott ,
Holly A. Swartz ,
David Cook ,
Danielle M. Novick  and
Ellen Frank
Andrea Fagiolini*
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
David J. Kupfer
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
John Scott
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
Holly A. Swartz
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
David Cook
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
Danielle M. Novick
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
Ellen Frank
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania (USA).
*
Address for correspondence: Dr. A. Fagiolini, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213 (USA). Fax: +1-412-246-5520 E-mail: fagiolinia@msx.upmc.edu
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Summary

Aims – This study evaluated the frequency and clinical significance of abnormal Thyroid Stimulating Hormone (TSH) and Free Thyroxine Index (FTI) in patients with bipolar I disorder treated primarily with lithium. Method – We evaluated the medical records of 143 participants in the Pittsburgh study of Maintenance Therapies in Bipolar Disorder who did not have a thyroid abnormality at entry. Results – Thirty-six percent of the 143 patients developed abnormal TSH and/or FTI values. Thirty-eight percent of the 135 patients who received lithium developed abnormal TSH and/or FTI, spent significantly longer time in the acute treatment phase (t = -3.6, df = 133, p = .0004), and had significantly higher mean Hamilton Scale for Depression scores over the course of the maintenance phase (t = -2.3, df = 71.6, p = .03). Time on lithium and development of abnormal TSH and/or FTI were positively correlated (r = .25, p = .004). Conclusions – Thyroid dysfunction can be frequent in patients exposed to lithium treatment for bipolar I disorder; it also appears to be correlated with a slower response to acute treatment, and may be related to poorer quality of long-term remission. A prospective study is needed to confirm our findings and determine whether more aggressive thyroid replacement can optimize thyroid function to facilitate clinical recovery.

Declaration of Interest: Supported in part by National Institute of Mental Health Grants MH 029618 (Drs. Frank and Fagiolini) and MH 030915 (Drs. Kupfer and Fagiolini), and the Bosin Memorial Fund of The Pittsburgh Foundation (Drs. Fagiolini, Kupfer, Cook, Scott, Novick and Frank). Dr. Fagiolini is on the advisory board and a consultant to Pfizer Inc, and Bristol Myers Squibb, and is on the speaker bureau of Bristol Myers Squibb, Eli Lilly Italy, Pfizer Inc, and Shire. Dr. Frank is on the advisory board of Pfizer Inc. and Eli Lilly & Company, and is a consultant to Pfizer Italia and Sender Amerique. Dr. Kupfer is on the advisory board of Pfizer, Inc., Forest Pharmaceuticals, Inc., and Solvay-Wyeth Pharmaceuticals, and is a consultant to Servier Amerique.

Keywords

hypothyroidismbipolar disorderlithiumthyroid stimulating hormone (TSH).
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 15 , Issue 2 , June 2006 , pp. 123 - 127
Copyright
Copyright © Cambridge University Press 2006

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References

REFERENCES

Biondi, B., Palmieri, E. A., Lombardi, G. & Fazio, S. (2002). Effects of sub-clinical thyroid dysfunction on the heart. Annals of Internal Medicine 137, 904 914.CrossRefGoogle Scholar
Bocchetta, A., Bernardi, F., Burrai, C., Pedditzi, M., Loviselli, A., Velluzzi, F., Martino, E. & Del Zompo, M. (1992). The course of thyroid abnormalities during lithium treatment: a two-year follow-up study. Acta Psychiatrica Scandinavica 86, 38–41.CrossRefGoogle ScholarPubMed
Calabrese, J.R., Gulledge, D.A., Hahn, K., Skwerer, R., Kotz, M., Schumacher, O.P., Gupta, M.K., Krupp, N. & Gold, P.W. (1985). Autoimmune thyroiditis in manic-depressive patients treated with lithium. American Journal of'Psychiatry 142, 1318–1321.Google ScholarPubMed
Canaris, G.J., Manowitz, N.R., Mayor, G. & Ridgway, E.C. (2000). The Colorado thyroid disease prevalence study. Archives of Internal Medicine 160, 526–534.CrossRefGoogle ScholarPubMed
Chu, J.W. & Crapo, L.M. (2002). Should mild subclinical hypothyroidism be treated? American Journal of Medicine 112, 422–423.CrossRefGoogle ScholarPubMed
Cole, D.P., Thase, M.E., Mallinger, A.G., Soares, J., Luther, J.F., Kupfer, D.J. & Frank, E. (2002). Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. American Journal of Psychiatry 159, 116–121.CrossRefGoogle ScholarPubMed
Denicoff, K.D., Leverich, G.S., Nolen, W.A., Rush, A. J., McElroy, S. L., Keck, P. E. Jr, Suppes, T., Altshuler, L. L., Kupka, R., Frye, M. A., Hatef, J., Brotman, M. A. & Post, R. M. (2000). Validation of the prospective NIMH-Life-Chart Method (NIMH-LCM-p) for longitudinal assessment of bipolar illness. Psychological Medicine 30, 1391–1397.CrossRefGoogle ScholarPubMed
Fagiolini, A., Kupfer, D.J., Houck, P.R., Novick, D.M. & Frank, E. (2003). Obesity as a correlate of outcome in patients with bipolar I disorder. American Journal of Psychiatry 160, 112–117.CrossRefGoogle ScholarPubMed
Frank, E., Swartz, H.A., Mallinger, A.G., Thase, M. E., Weaver, E.V. & Kupfer, D.J. (1999). Adjunctive psychotherapy for bipolar disorder: effects of changing treatment modality. Journal of Abnormal Psychology 108, 579–587.CrossRefGoogle ScholarPubMed
Frank, E., Swartz, H. & Kupfer, D.J. (2000). Interpersonal and social rhythm therapy: managing the chaos of bipolar disorder. Biological Psychiatry 48, 593–604.CrossRefGoogle ScholarPubMed
Haggerty, J.J. Jr, Stern, R.A., Mason, G.A., Beckwith, J., Morey, C.E. & Prange, A.J. Jr, (1993). Subclinical hypothyroidism: a modifiable risk factor for depression? American Journal of Psychiatry 150, 508–510.Google ScholarPubMed
Johnston, A.M. & Eagles, J.M. (1999). Lithium-associated clinical hypothyroidism: prevalence and risk factors. British Journal of Psychiatry 175, 336–339.CrossRefGoogle ScholarPubMed
Kessling, L.V., Sondergard, L., Kvist, K. & Andersen, P.K. (2005). Suicide risk in patients treated with lithium. Archives of General Psychiatry 62, 860–866.CrossRefGoogle Scholar
Kleiner, J., Altshuler, L., Hendrick, V., & Hershman, J.M. (1999). Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment. Journal of Clinical Psychiatry 60, 249–255.CrossRefGoogle ScholarPubMed
Lazarus, J.H., John, R., Bennie, E. H., Chalmers, R.J. & Crockett, G. (1981). Lithium therapy and thyroid function: a long-term study. Psychological Medicine 11, 85–92.CrossRefGoogle ScholarPubMed
Maarbjerg, K., Vestergaard, P. & Schou, M. (1987). Changes in serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) during prolonged lithium treatment. Acta Psychiatrica Scandinavica 75, 2217–2221.CrossRefGoogle ScholarPubMed
McDermott, M.T. & Ridgway, E.C. (2001). Subclinical hypothyroidism is mild thyroid failure and should be treated. Journal of Clinical Endocrinology and Metabolism 86, 4585–4590.CrossRefGoogle ScholarPubMed
Muller, B., Tsakiris, D.A., Roth, C.B., Guglielmetti, M., Staub, J.J., & Marbet, G.A. (2001). Haemostatic profile in hypothyroidism as potential risk factor for vascular or thrombotic disease. European Journal of Clinical Investigation 31, 131–137.CrossRefGoogle ScholarPubMed
Myers, D.H., Carter, R.A., Burns, B.H., Armond, A., Hussain, S.B. & Chengapa, V.K. (1985). A prospective study of the effect of lithium on thyroid function and on the prevalence of antithyroid antibodies. Psychological Medicine 15, 55–61.CrossRefGoogle ScholarPubMed
Ridgway, E.C., Ladenson, P.W., Cooper, D.S., Daniels, G.H., Francis, G.S. & Maloof, F. (1982). Cardiac function in mild and severe primary hypothyroidism. Life Sciences 30, 651–658.CrossRefGoogle ScholarPubMed
Smigan, L., Wahlin, A., Jacobsson, L. & von Knorring, L. (1984). Lithium therapy and thyroid function tests: a prospective study. Neuropsychobiology 75, 2217–2221.Google Scholar
Transbol, I., Christiansen, C. & Baastrup, P.C. (1978). Endocrine effect of lithium, I: hypothyroidism, its prevalence in long-term treated patients. Acta Endocrinologica (Copenh) 87, 759–767.Google ScholarPubMed
Vincent, A., Baruch, P. & Vincent, P. (1993). Early onset of lithium-associated hypothyroidism. Journal of Psychiatry & Neuroscience 18, 74–77.Google ScholarPubMed
Vitale, G., Galderisi, M. & Lupoli, G.A., Celentano, A., Pietropaolo, I., Parenti, N., De Divitiis, O. & Lupoli, G. (2002). Left ventricular myocardial impairment in subclinical hypothyroidism assessed by a new ultrasound tool: pulsed tissue doppler. Journal of Clinical Endocrinology & Metabolism 87, 4350 4355.CrossRefGoogle ScholarPubMed
Yassa, R., Saunders, A., Nastase, C. & Camille, Y. (1988). ithium-induced thyroid disorders: a prevalence study. Journal of Clinical Psychiatry 49, 14–16.Google ScholarPubMed