Lithiuminduced thyroid abnormalities Ppt Powerpoint Presentation slides Dr George kirov Medical Slideshow Thyroid Disease Symptoms: Enlarged Thyroid Thyroid Nodules

Lithiuminduced thyroid abnormalities

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Slide 1 :

Thyroid abnormalities in patients treated with Lithium Dr. George Kirov, Cardiff University Cardiff, Wales

Slide 2 :

Thyroid disorders and psychiatric illness Thyroid disorders present with psychiatric symptoms Blunted TSH response to TRH in 25-30% of depressed patients. T4 levels are reduced after clinical recovery from depression (found in 17 out of 18 studies) Thyroid hormones potentiate tricyclic antidepressants (10 studies with T3 showed a 55% response), STAR*D trial confirms results with 25% remission rate Thyroid hormones have been used to treat periodic catatonia and rapid cycling Bipolar Disorder

Slide 3 :

A genetic study on bipolar disorder conducted by the author found many families with thyroid history. Blue: hypothyroidism, red: thyrotoxicosis

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The Whickham Survey of thyroid disorders Population based sample of 2779 people in UK, mean age 48 who were followed up for 20 years (1995): 1051 women, and 826 men; mean age 59 Thyrotoxicosis: Women: 3.9%, 0.8/1000 survivor/years Men: 0.2% (0 on follow-up) Hypothyroidism: Women: 9.3% (69 women on follow-up) Men: 1.3% (10 men on follow-up)

Slide 7 :

Wickham Survey: Age specific hazard for thyroid disorders in women

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Study 1: The Maudsley sample One lithium test in a 20 months period Diagnosis: BPI, BPII, UP, SA

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Sample characteristics, Maudsley females males Numbers 119 82 Age 53, (SD=18) 53, (SD=16) Onset 33, (SD=16) 30, (SD=14) Age Lithuim 46, (SD=18) 45, (SD=18) Years on Li 5.5 7.5

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Results (part 1) Pre-lithium abnormalities: 8 patients (all female), 6 thyrotoxic, 2 hypothyroid 4.9% thyrotoxicosis in females (3.9% in the Wickham Survey) 1.64 cases per 1000 survivor/years (1.45 if age at onset is 12 years) (0.8 in the Wickham Survey)

Slide 11 :

Results, (part 2) Lithium-induced hypothyroidism Joffe and Levitt (1993) reviewed 27 studies with 2926 patients. Mean rate: 5.8%, range from 0 to 47% Female patients consistently more likely to suffer (110 female vs. 14 male patients reported in 7 studies, 24.7% vs. 9.6%) Vincent (1993): 74% developed hypothyroidism in the first 2 years Yassa (1988): risk is highest in the first four years Transbol (1978); Vincent (1993): age is a risk factor

Slide 12 :

Survival Functions, for lithium-induced hypothyroidism. Maudsley Sample

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Results, (part 3) Post-lithium thyrotoxicosis Definitive studies are lacking, mostly case reports Maudsley study: one male and one female patient became thyrotoxic. Bias probably operating

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The replication sample Family study: Systematic ascertainment of lithium clinics 110 trios with a BPI (96), BPII (9) or SA(M) (5) proband Both parents alive and interviewed for thyroid history Mean age of probands: 35 years (SD = 8.8) Association sample: 162 patients from lithium clinics in South Wales and Southampton, including 49 UP, interviewed in person Mean age: 52.5 (SD = 13.2)

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Survival for hypo- or hyperthyroidism before start of Lithium treatment Males 114 3 hypo 1 toxic Females 160 4 hypo 4 toxic

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Survival for hypo- or hyperthyroidism during Lithium treatment. Cardiff study Males 110 3 hypo 2 toxic Females 148 26 hypo 7 toxic

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Rate of thyrotoxicosis in the replication sample Age 16 on lithium 162 women period at risk for pre-Li thyrotoxicosis Age 38 Age 44 1.1/1000 survivor/years 7.7/1000 survivor/years 4 cases 7 cases 1 case 2 cases 116 men 2.7/1000 survivor/years

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The prospective study: Kirov et al, J Affective Disorders, 2005, 87:313-317 57 Patients taking lithium 33 females, 24 males, 42 BP, 15 UP No pre-lithium abnormalities At least 6 months of follow-up Observation length: 53.1 months (14-87) Antibodies checked at 1 or 2-years intervals Outcome: 1 thyrotoxic, 4 hypothyroid, all female Incidence of 27.4/1000 survivor-years for hypothyroidism

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Treatment In this author’s opinion it is usually more beneficial for the patient to treat the hypothyroidism with thyroxine, rather than to stop the lithium treatment.

Slide 20 :

13/62 negative cases (21%) 14/24 positive cases (58%)

Slide 21 :

	kirov@cardiff.ac.uk 1 Years ago. Category: Psychiatry

Tags:	Psychiatry

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