ABSTRACT
BACKGROUND: To determine thyroid gland volume and the prevalence of goiter in patients receiving long-term lithium treatment for affective disorders. METHODS: In this cross-sectional study, we performed ultrasonographic examinations in 96 patients on long-term lithium treatment, including those with bipolar, major depressive, and schizoaffective disease. Patients with documented continuous and adequate serum lithium levels for more than or equal to 6 months were recruited consecutively from the Berlin Lithium Clinic. Ultrasonographic examinations were also performed in 96 gender- and age-matched control subjects. Patients and controls were 18 years of age or older and were residents of Berlin, Germany and surrounding areas. RESULTS: Total thyroid volume was significantly greater in the lithium-treated group than among controls (23.7 ml vs. 13.6 ml). Ultrasonography detected that significantly more lithium-treated subjects had goiter than did control subjects (N=53 vs. N=19). Clinical inspection and palpation only detected goiter in 24 of the lithium-treated patients and in 12 control subjects. In a patient subgroup taking levothyroxine, the prevalence of goiter was still 37%. Patients who were not taking levothyroxine had significantly higher TSH basal levels than normal controls (2.1 mU/L vs. 1.3 mU/L). LIMITATIONS: Cross-sectional study; no control for other factors related to thyroid enlargement and goiter such as dietary issues, smoking, or iodine intake; affectively ill subjects were treated with additional psychotropic medications. CONCLUSIONS: Thyroid enlargement was found in a significant number of lithium-treated patients. Ultrasonography proved superior to palpatory inspection in detecting goiter. Regular use of ultrasonography for early detection of thyroid enlargement in patients on long-term lithium treatment is therefore recommended.
Subject(s)
Antidepressive Agents/adverse effects , Bipolar Disorder/drug therapy , Depressive Disorder, Major/drug therapy , Goiter , Lithium Carbonate/adverse effects , Psychotic Disorders/drug therapy , Thyroid Gland , Adolescent , Adult , Antidepressive Agents/therapeutic use , Bipolar Disorder/epidemiology , Cross-Sectional Studies , Depressive Disorder, Major/epidemiology , Female , Goiter/chemically induced , Goiter/diagnostic imaging , Goiter/epidemiology , Humans , Lithium Carbonate/therapeutic use , Male , Middle Aged , Prevalence , Psychotic Disorders/epidemiology , Thyroid Gland/anatomy & histology , Thyroid Gland/diagnostic imaging , Thyroid Gland/drug effects , UltrasonographyABSTRACT
OBJECTIVE: Because the role of thyroid autoimmunity in the development of lithium-induced thyroid dysfunction remains controversial, we compared the prevalence of thyroid autoantibodies in patients with affective disorders receiving long-term lithium maintenance therapy with that of age- and sex-matched controls. METHODS: We conducted a cross-sectional study with 100 adult patients with major affective disorders diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, revised (DSM-III-R), who were undergoing lithium therapy for 6 months or more at a specialized lithium university clinic and 100 age- and sex-matched controls with no history of an axis I psychiatric disorder. Serum autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TgAb) and TSH receptors (TRAb) were measured. RESULTS: TPOAb were found in 7 patients and 11 controls, and TgAb were found in 8 patients and 15 controls. TRAb were not found in either group. CONCLUSIONS: In this sample of patients with affective disorders, long-term lithium treatment did not increase the prevalence of thyroid autoimmunity.