Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment

Article Abstract:

Long-term maintenance therapy with lithium is frequently prescribed for individuals with manic depression. Lithium is known to increase the serum levels of thyrotropin and decrease the levels of thyroid hormone. Reports of thyroid abnormalities in patients receiving long-term lithium therapy have not been consistent. This study investigated the incidence of goiter, assessed thyroid function and measured thyroid size in a group of manic-depressive patients. The frequency of these thyroid conditions was analyzed in relation to duration of lithium treatment. Also, indications of thyroid autoimmunity were evaluated. Subjects were divided into three groups: 19 patients who never received lithium therapy, used as a control group; 25 patients who had been treated with lithium for one to five years; and 50 patients who had been receiving lithium for more than 10 years. In addition to laboratory and ultrasonic scanning procedures, all patients were assessed for use of other drugs, smoking and drinking habits, and other diseases, past and present. The results showed that goiter developed in 44 percent of the group treated for one to five years, in 50 percent of those treated for over 10 years, and in only 16 percent of the untreated patients. In the control group, both thyroid size and goiter were influenced by patient smoking habits; smokers had larger thyroids and more goiter than nonsmokers. But this difference was not observed in the groups of patients receiving lithium; no differences in thyroid size or incidence of goiter were observed between smokers and nonsmokers. An above-normal frequency of hypothyroidism (under-active thyroid) was seen in lithium-treated patients (4 percent in patients treated between one and five years and 21 percent in those treated for over 10 years). The majority of patients had normal serum thyrotropin levels, and no cases of autoimmunity were detected. It is concluded that lithium may have direct effects upon the thyroid gland. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Bipolar disorder, Thyroid gland

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Comparison of the effects of hydrochlorothiazide and furosemide on lithium disposition

Article Abstract:

Lithium is commonly used in treating psychiatric conditions such as bipolar disorder (manic depression). When used as a maintenance medication, lithium levels must be carefully controlled. Blood levels of lithium can be altered, if the patient is taking other drugs that react with the lithium. Diuretics, drugs that increase the secretion of urine, are thought to increase lithium retention. Studies have shown this occurs when sodium-depleting diuretics are taken, but other classes of diuretics have not been as well studied. A diuretic that does not cause this reaction is desirable, because patients taking lithium may also develop a disorder requiring diuretic treatment, such as high blood pressure. This study examined the effects of two diuretics from different classes, furosemide and hydrochlorothiazide, on lithium levels in 13 subjects. The subjects were healthy, male volunteers, who were given lithium for six weeks and either furosemide, hydrochlorothiazide, or a placebo for one week during weeks two, four, and six. Serum lithium levels were measured at the beginning of each week during which the other drugs were given, and then again on day five of the drug treatment. Serum lithium levels were significantly higher on day five compared with baseline levels when the subjects received hydrochlorothiazide. There were no significant changes when either the placebo or when furosemide was given. Diuretic activity, including sodium excretion, was significantly greater with hydrochlorothiazide than with either the placebo or furosemide. These results should be interpreted with caution; the subjects in this study were healthy volunteers, rather than patients, and therapeutic doses of lithium were not administered. However, it appears that furosemide may be a safe diuretic to prescribe in conjunction with lithium. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Research, Physiological aspects, Drug interactions, Hydrochlorothiazide, Diuretics, Furosemide

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