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Lithium and hypothyroidism


Bandolier is often asked about either the need for monitoring thyroid function in patients on lithium therapy, or how frequently it should be done, or both.

Systematic review


A review of the English language literature found on MEDLINE [1] reports the prevalence of overt hypothyroidism to be 8% to 15% in patients taking lithium, compared with about 1% in the general population. It suggests that baseline thyroid function should be assessed before starting lithium, with a symptom checklist at two-monthly intervals, and with laboratory tests three months after starting lithium treatment and thereafter every six to 12 months.

Age and sex


A survey of 209 patients with affective disorder from one catchment area [2] concluded that six female patients had thyrotoxicosis before starting treatment. Thereafter 20 patients developed hypothyroidism, 3% of men and 15% of women. No patient developed hypothyroidism within five years of starting treatment if lithium was started before the age of 50 years. There was a distinct trend for women patient over the age of 50 years to have increased risk of developing hypothyroidism.

The report suggests more frequent thyroid testing (every three months) for women aged over 45 or 50 years, with less frequent testing (every six or 12 months) for men and younger women.

Reference:

  1. J Kleimer, L Altshuler, V Hendrick, JM Hershman. Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment. Journal of Clinical Psychiatry 1999 60: 249-255.
  2. G Kirov. Thyroid disorders in lithium-treated patients. Journal of Affective Disorders. 1998 50: 33-40.
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