Effect of lithium maintenance therapy on thyroid and parathyroid function.

OBJECTIVES: To assess changes induced by lithium maintenance therapy on the incidence of thyroid, parathyroid and ion alterations. These were evaluated with respect to the duration of lithium therapy, age, sex, and family history (whether or not the patient had a first-degree relative with thyroid disease). DESIGN: Prospective study. SETTING: Affective Disorders Clinic at St. Mary's Hospital, Montreal. PATIENTS: One hundred and one patients (28 men and 73 women) with bipolar disorder receiving lithium maintenance therapy ranging from 1 year's to 32 years' duration. The control group consisted of 82 patients with no psychiatric or endocrinological diagnoses from the hospital's out-patient clinics. OUTCOME MEASURES: Laboratory analyses of calcium, magnesium and thyroid-stimulating hormone levels performed before beginning lithium therapy and at biannual follow-up. RESULTS: Hypothyroidism developed in 40 patients, excluding 8 patients who were hypothyroid at baseline. All patients having first-degree relatives affected by thyroid illness had accelerated onset of hypothyroidism (3.7 years after onset of lithium therapy) compared with patients without a family history (8.6 years after onset of lithium therapy). Women over 60 years of age were more often affected by hypothyroidism than women under 60 years of age (34.6% versus 31.9%). Magnesium levels in patients on lithium treatment were unchanged from baseline levels. After lithium treatment, calcium levels were higher than either baseline levels or control levels. Thus, lithium treatment counteracted the decrease in plasma calcium levels associated with aging. CONCLUSIONS: Familial thyroid illness is a risk factor for hypothyroidism and hypercalcemia during lithium therapy.

Predictors of lithium treatment responsiveness in bipolar patients. A two-year prospective study.

Twenty-nine bipolar patients were assessed before the start of lithium therapy to study the prognostic criteria of long-term response to therapy. Assessment included clinical and demographic data and laboratory tests administered before and 2-5 days after initiation of therapy. The tests included calcium and magnesium serum levels, and thyroid hormonal status. Patients were followed up for 2 years. None of the single variables predicted the response to lithium therapy, but a combination of clinical and demographic variables, used in a discriminant function analysis, correctly identified 78.9% of responders. Multiple regression analysis predicted 46.2% of the outcome. The strongest univariate predictors were mood quality, illness duration, and substance abuse.

Effect of lithium maintenance treatment on hypothalamic pituitary gonadal axis in bipolar men.

This was a cross-sectional study assessing short- and long-term effects of lithium (Li) treatment on hormone levels. Levels of testosterone (T), prolactin (PRL), luteinizing hormone (LH), and follicule-stimulating hormone (FSH) were compared. Sixty-one lithium-treated, euthymic, stable, bipolar men were compared with 67 hospital controls and 22 healthy volunteers. Prolactin (P < or = 0.01) and luteinizing hormone (P < or = 0.001) were higher in all patients compared with healthy volunteers. Li-treated patients were evaluated at 22 to 24 mo, 2 to 5 y, and after more than 5 y of Li therapy. At 22 to 24 mo of Li treatment, levels of PRL and LH did not differ from the values of healthy volunteers or of patients treated for longer periods. In addition, the value of T was higher (P < or = 0.003) than in the group treated longer. Levels of T after more than 5 y of treatment, however, did not differ from those of the healthy volunteers.

Renal reactions to changes of lithium dosage.

The renal function was assessed in 51 bipolar patients on multiple-dosage lithium maintenance therapy from 1 to 22 years, after placing them on single (HS) dosage for 12-18 months. Serum lithium levels were maintained constant at a level of 0.8 mg/l. The patients were divided into three groups according to duration of previous multiple doses (b.i.d.-q.i.d.) Li therapy; less than 5 years; 5-10 years; 10-22 years. The improvement in water handling occurred only in the previously shortest multiple-dosage-treated patients and the duration of previous multiple dosage negatively influenced water handling; however, all laboratory analyses remained within normal limits. None of the patients showed clinical worsening or had an affective episode. The separate analyses showed associated gender differences in urinary volume, serum creatinine, and creatinine clearance values. Our findings confirmed the beneficial renal reaction to single-dose posology, as well the female sensitivity to Li therapy in general, and especially with concomitant antipsychotic medication.

Thyroid functioning during treatment for depression.

Thirty-nine unipolar depressed patients were treated, after a washout period of seven days in a double blind study with either moclobemide, placebo or amitriptyline, for 42 days. The psychopathological assessment and HRSD were done on seven day intervals and thyroid analysis was done on 14 day intervals. At the end of therapy, the levels of T4 and fT4 decreased significantly in the responders if amitriptyline was used, and non-significantly if placebo or moclobemide were used. The T4 and fT4 values of the non-responders increased non-significantly. The weight change was minimal and non-significant.

Grade II and grade III hypothyroidism in rapid-cycling bipolar patients.

Thyroid function was evaluated in 10 rapid-cycling bipolar patients who had previously responded to lithium treatment. Five patients had grade II and 1 patient had grade III hypothyroidism as determined by thyrotropin-releasing hormone tests. Treatment with thyroxine in addition to lithium significantly decreased the intensity and frequency of rapid cycling episodes.

Diurnal rhythms of plasma cortisol, beta-endorphin and prolactin, and cerebrospinal fluid amine metabolite levels before suicide. Case report.

There are indications to suggest a relationship between low levels of 5-hydroxy-indoleacetic acid (5HIAA) in the cerebrospinal fluid and suicidal behavior. Many depressed patients show an elevated cortisol secretion. As beta-endorphin is derived from the same precursor as ACTH, it is expected that plasma beta-endorphin levels will also rise in depressed patients. We report here a case of severe depression with diurnal variation who showed low CSF 5HIAA prior to his suicide. In contrast, his catecholamine metabolites were 50% above the mean values of other depressed patients. Hormonal measurements, however, showed low cortisol, prolactin and beta-endorphin levels.

Growth hormone treatment in hypopituitary dwarfs: longitudinal psychological effects.

This is one of a series of studies on the psychological effects of medically induced growth in a group of hypopituitary dwarfs treated with Human Growth Hormone (HGH). Before treatment these dwarfs were found to be psychologically immature and hypoactive, without any manifestation of aggressive drives, and had an underlying low self-esteem when compared with the normal population. When compared with a matched group with constitutional growth delay the hypopituitary patients were found to use denial, whereas the control group used well-organized compensatory mechanisms (9). Immaturity was found in both groups. When the hypopituitary dwarfs reached adolescence they lacked the core attributes of masculinity or femininity and manifested some ambiguity or even inversion in their choice of gender role (10). This report deals with their psychological evolution in relation to physical growth.