The effect of including other psychotropic medications into a long-term bipolar disorder lithium treatment on thyroid function

Background/Aims. Long-term bipolar disorder (BD) treatment with lithium exerts a significant effect on thyroid structure and function. Compared with BD patients who do not take lithium, patients treated with lithium have higher concentrations of thyroid-stimulating hormone (TSH) and free thyroxine (FT4), lower concentrations of free triiodothyronine (FT3), higher thyroid volume and higher occurrence of goitre. The aim of the study was to compare thyroid structure and function in relation to the inclusion of other mood stabilisers and antidepressants into a lithium treatment. Method. The studied group consisted of eighty BD patients (27 male, 53 female) aged 24–85 years, receiving a prophylactic lithium treatment for the average of 19 ± 9 years. Fifteen patients underwent lithium monotherapy; in 17, lithium was administered concurrently with carbamazepine; in 17, concurrently with quetiapine; and in 11, concurrently with valproate. In 20 subjects, lithium was administered concurrently with antidepressants. Results. In comparison with patients on lithium monotherapy, in patients who took lithium and antidepressant drugs, the concentrations of TSH were significantly higher, while in patients who took lithium and carbamazepine the concentrations of FT4 were lower. The concentrations of thyroid peroxidase antibodies (TPOAb) were significantly higher in patients who took lithium concurrently with antidepressants and concurrently with valproate. The highest frequency of goitre (70%) was observed in patients who took lithium concurrently with antidepressants. Conclusions. The obtained results may suggest a significant effect of including other mood stabilisers and antidepressants into a long-term lithium treatment on thyroid structure and function. A limitation of the study is the small size of the groups.

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The effect of long-term lithium administration on thyroid function and structure as compared with monotherapy by other mood stabilising drugs – a preliminary study

Pharmacotherapy in Psychiatry and Neurology ◽

10.33450/fpn.2019.11.001 ◽

2020 ◽

Vol 35 (3-4) ◽

pp. 169-176

Author(s):

Agnieszka Kraszewska ◽

Ewa Ferensztajn-Rochowiak ◽

Janusz Rybakowski

Keyword(s):

Antidepressant Drugs ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Structure And Function ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Long Term Treatment ◽

Preliminary Study ◽

And Function

Aims: Long-term treatment with lithium in patients with bipolar disorder (BD) exerts a significant effect on thyroid structure and function. Previously, it was found that adding to lithium other mood stabilising or antidepressant drugs can also be important. The aim of this preliminary study was to compare thyroid structure and function in patients with BD receiving long-term lithium monotherapy with monotherapy using other mood stabilising drugs, such as carbamazepine, valproates or quetiapine. Method: Forty-one BD patients were studied (13 male, 28 female) aged 28–80 years. In 15, monotherapy with lithium was given; in 10 – with carbamazepine; and in 8 – with valproate and quetiapine. In all patients, the thyroid-stimulating hormone (TSH), free thyroxine (fT3) free triiodothyronine (fT4), and the antibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb) and TSH receptors (TSHRAb) were estimated. Goiter was diagnosed when the thyroid volume exceeded 18 cm3 in women and 25 cm3 in men. Results: The groups were of similar age; however, the duration of quetiapine therapy was shorter than lithium or carbamazepine. Comparing to patients on lithium monotherapy, the median of TSH concentration was lower in patients on quetiapine, and the median of TPOAB lower in patients on valproates. The highest frequency of goiter (47%) was observed in patients receiving lithium. Conclusions: The results obtained may suggest that among the studied mood stabilisers, lithium exerts the biggest goiter-inducing effect. The differences between groups as to thyroid hormones and antibodies were not significant. The limitation of the study was a small number of studied patients.

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No Connection between Long-Term Lithium Treatment and Antithyroid Antibodies

Pharmacopsychiatry ◽

10.1055/a-0838-6062 ◽

2019 ◽

Vol 52 (05) ◽

pp. 232-236 ◽

Cited By ~ 3

Author(s):

Agnieszka Kraszewska ◽

Katarzyna Ziemnicka ◽

Jerzy Sowiński ◽

Ewa Ferensztajn-Rochowiak ◽

Janusz K. Rybakowski

Keyword(s):

Filtration Rate ◽

Lithium Treatment ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Antithyroid Antibodies ◽

Female Patients ◽

Bipolar Patients

Abstract Introduction The studies on the effect of lithium treatment on antithyroid antibodies showed either a higher concentration of these antibodies in patients receiving lithium compared to those lithium-naive or no difference between these groups. In lithium-treated bipolar patients, some researchers pointed to an association between antithyroid antibodies and other features of thyroid dysfunction such as hypothyroidism and decrease of glomerular filtration rate. Methods We compared antithyroid antibodies in 98 patients (30 male, 68 female) with bipolar disorder, aged 62±13 years, who received lithium for 19±10 years to 39 patients (12 male, 27 female), aged 57±10 years, who were never treated with lithium. The antibodies against thyroid peroxidase (TPOAb), against thyroglobulin (TGAb), and thyroid-stimulating hormone (TSH) receptors (TSHRAb) were estimated. Results No difference in the percentages of antibodies occurrence was found between groups, although the concentrations of TGAb were higher in patients receiving lithium. In lithium-treated patients, the presence of TPOAb was associated with lower concentrations of free triiodothyronine and the presence of TGAb, with higher concentrations of TSH. In females, the levels of TGAb were associated with lower thyroid volume. The concentrations of TPOAb correlated positively with the duration of lithium therapy in males, and those of TPOAb and TGAb negatively, with such duration, in female patients. Conclusion The results obtained showed no significant connection between long-term lithium treatment and antithyroid antibodies. In bipolar patients receiving lithium longitudinally, antithyroid antibodies can be associated with some indexes of thyroid function. However, they behave differently in male and female patients.

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Thyroid Functions in Bamboo-Shoots Consuming Children of Tripura, North-east India

10.21203/rs.3.rs-615916/v1 ◽

2021 ◽

Author(s):

Indrajit Ray ◽

A. K. Chandra ◽

Saru Kumar Debbarma ◽

Sekhar Kumar Mookerjee ◽

Ajoy Datta ◽

...

Keyword(s):

Urinary Iodine ◽

Thyroid Volume ◽

Thyroid Stimulating Hormone ◽

Consumption Pattern ◽

Thyroid Peroxidase ◽

Free Triiodothyronine ◽

Cross Sectional ◽

North East ◽

Bamboo Shoots ◽

The Village

Abstract PurposeInformation on thyroid functions in populations consuming potent antithyroidal bamboo-shoots (BS) was found scanty. Therefore, to assess thyroid function in BS consuming children was found relevant.MethodsThis cross-sectional study included 127 children from 3 villages. Thyroid volume (TV), free thyroxine (FT4), free triiodothyronine (FT3), thyroid stimulating hormone (TSH), thyroglobulin antibody (Tg-Ab), thyroid peroxidase antibody (TPO-Ab), urinary iodine (UI), urinary thiocyanate (USCN), salt iodine (SI), water iodine (WI), and BS consumption pattern were assessed. ResultsVariable-wise overall mean±SDs/medians/interquartile ranges (IQR) were - age: 8.69±1.69/8.77/7.22-9.74 y, TVol: 0.82±0.27/0.82/0.67-0.96 ml, FT4: 19.5+5.6/20.1/16.9-22.0 pmol/L, FT3: 4.27+1.24/4.22/3.35-4.96 pmol/L, TSH: 2.44+1.39/2.33/1.60-3.15 mIU/L, Tg-Ab: 15.2+10.0/12.5/11.1-14.5 IU/ml, TPO-Ab: 5.58+12.25/3.89/2.90-5.11 IU/ml, UI: 117.4±58.5/108/73-160.5 µg/L, USCN: 0.99+0.67/0.8/0.5-1.2 mg/dl, WI: 4 .69±4.56/3.0/1.35–7µg/L, and BS consumption: 153.8±01.4/119/71.4–214.3 g/person/day respectively. Only 80.3% salt samples had ≥15 ppm iodine. Thyroid dysfunction prevalence was 6.3%. There were positive correlations between TV and FT4 (r=0.2466, p=0.005), UI and TSH (r=0.2633, p=0.003), TSH and FT4 (r=0.2135, p=0.016), TSH and FT3 (r=0.1898, p=0.033), USCN and FT4 (r=0.2477, p=0.005), Tg-Ab and TPO-Ab (r=0.3768, p=<0.001), and negative correlations between Tg-Ab and TSH (r=-0.2024, p=0.023), Tg-Ab and FT4 (r=-0.1869, p=0.035). In boys, USCN had a positive correlation with TPO-Ab (r=0.3069, p=0.018). The village having highest levels of BS consumption (p=0.037) and median UI showed higher TSH levels (p=0.037) and higher FT3 level (p=0.001) compared to the village of lowest BS consumption.ConclusionsThe BS consuming children appear at risk of developing hypothyroidism by Tg-Ab, which may partly be diminished by reducing BS consumption.

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Cardioprotective potential of lithium and role of fractalkine in euthymic patients with bipolar disorder

Australian & New Zealand Journal of Psychiatry ◽

10.1177/00048674211062532 ◽

2021 ◽

pp. 000486742110625

Author(s):

Pao-Huan Chen ◽

Cheng-Yi Hsiao ◽

Shuo-Ju Chiang ◽

Ruei-Siang Shen ◽

Yen-Kuang Lin ◽

...

Keyword(s):

Bipolar Disorder ◽

Cardiovascular Risk ◽

Lithium Treatment ◽

Structure And Function ◽

Cardiac Structure ◽

High Cardiovascular Risk ◽

Cohen’S D ◽

Cardiac Structure And Function ◽

And Function ◽

Cohen's D

Objective: Over a half century, lithium has been used as the first-line medication to treat bipolar disorder. Emerging clinical and laboratory studies suggest that lithium may exhibit cardioprotective effects in addition to neuroprotective actions. Fractalkine (CX3CL1) is a unique chemokine associated with the pathogenesis of mood disorders and cardiovascular diseases. Herein we aimed to ascertain whether lithium treatment is associated with favorable cardiac structure and function in relation to the reduced CX3CL1 among patients with bipolar disorder. Methods: We recruited 100 euthymic patients with bipolar I disorder aged over 20 years to undergo echocardiographic study and measurement of plasma CX3CL1. Associations between lithium treatment, cardiac structure and function and peripheral CX3CL1 were analyzed according to the cardiovascular risk. The high cardiovascular risk was defined as (1) age ⩾ 45 years in men or ⩾ 55 years in women or (2) presence of concurrent cardiometabolic diseases. Results: In the high cardiovascular risk group ( n = 61), patients who received lithium as the maintenance treatment had significantly lower mean values of left ventricular internal diameters at end-diastole (Cohen’s d = 0.65, p = 0.001) and end-systole (Cohen’s d = 0.60, p = 0.004), higher mean values of mitral valve E/A ratio (Cohen’s d = 0.51, p = 0.019) and superior performance of global longitudinal strain (Cohen’s d = 0.51, p = 0.037) than those without lithium treatment. In addition, mean plasma levels of CX3CL1 in the high cardiovascular risk group were significantly lower among patients with lithium therapy compared with those without lithium treatment ( p = 0.029). Multiple regression models showed that the association between lithium treatment and mitral value E/A ratio was contributed by CX3CL1. Conclusion: Data from this largest sample size study of the association between lithium treatment and echocardiographic measures suggest that lithium may protect cardiac structure and function in patients with bipolar disorder. Reduction of CX3CL1 may mediate the cardioprotective effects of lithium.

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Cytomorphological alterations of thyroid gland consequent upon fluorosis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20190001 ◽

2019 ◽

Vol 7 (2) ◽

pp. 544

Author(s):

Jwalaram Kumar Chaluvadi ◽

Srinivasulu Kande ◽

Viswa Kumar Ramalinga ◽

Vijay Kumar Kutala ◽

Vijay Kumar J.

Keyword(s):

Thyroid Gland ◽

Thyroid Function ◽

Biochemical Parameters ◽

Follicular Adenoma ◽

Thyroid Function Test ◽

Thyroid Stimulating Hormone ◽

Structure And Function ◽

Free Triiodothyronine ◽

And Function ◽

The Impact

Background: Study aimed at assessing the impact of elevated fluoride from drinking water on thyroid gland structure and function in fluorosis prone areas. Iodine is incorporated in the thyroid synthesis by thyroid gland but in the presence of low Iodine levels fluoride is likely to interfere with the concentrating capacity of thyroid of iodine in thyroid production, consequently reflecting changes in thyroid parameters and also cytomorphological features manifesting hypothyroidism in association with different pathological entities.Methods: Prakasam district in Andhra Pradesh is fluorosis prone zone and subjects are picked up from highly vulnerable zone in this district and their specimens are collected to study cytomorphological changes of the thyroid gland and biochemical parameters of blood samples for thyroid function test were considered. Cytological study by way of Fine Needle Aspiration Cytology (FNAC) of thyroid gland, biochemical parameters pertaining to function of thyroid gland namely Free triiodothyronine (FT3), Free Thyroxine (FT4) and Thyroid stimulating hormone (TSH) were assessed in the subjects from fluorosis prone zone.Results: The results were statistically significant with concurrent association of different cytological alterations of thyroid gland in these subjects like Hashimoto’s thyroiditis of hypothyroidism, adenomatous goitre, colloid goitre and few of follicular adenoma/neoplasm. FNAC makes cytological changes evident showing different morphological features that comprise different pathological entities largely with an evidence of hypothyroidism in most of the cases in the given study.Conclusions: The results of the study strongly suggest assessing the magnitude of the problem of fluorosis and also magnitude of its influence on thyroid structure and function that warrants assessment of the thyroid function by biochemical and cytological studies.

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Long-term lithium treatment of bipolar disorder influences very small embryonic-like stem cells and mRNA expression of pluripotency and glial markers

10.26226/morressier.5971be83d462b80290b52f69 ◽

2017 ◽

Author(s):

Ewa Ferensztajn

Keyword(s):

Stem Cells ◽

Bipolar Disorder ◽

Mrna Expression ◽

Lithium Treatment

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Lung Structure And Function Relation In Elastase-Treated Rats: A Long-Term Follow Up Study

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6405 ◽

2012 ◽

Author(s):

Margit V. Szabari ◽

Jozsef Tolnai ◽

Balazs Maar ◽

Harikrishnan Parameswaran ◽

Elizabeth Bartolak-Suki ◽

...

Keyword(s):

Structure And Function ◽

Follow Up Study ◽

Lung Structure ◽

Long Term Follow Up ◽

And Function ◽

Function Relation

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Akt-mTOR hypoactivity in bipolar disorder gives rise to cognitive impairments associated with altered neuronal structure and function

Neuron ◽

10.1016/j.neuron.2021.03.008 ◽

2021 ◽

Author(s):

Amanda M. Vanderplow ◽

Andrew L. Eagle ◽

Bailey A. Kermath ◽

Kathryn J. Bjornson ◽

Alfred J. Robison ◽

...

Keyword(s):

Bipolar Disorder ◽

Cognitive Impairments ◽

Structure And Function ◽

Neuronal Structure ◽

And Function

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Abstract P138: Long-term Effects Of Severe Caloric Restriction To The Heart Function

Hypertension ◽

10.1161/hyp.78.suppl_1.p138 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Aline M De Souza ◽

Jonathas Almeida ◽

Nataliia Shults ◽

Hong Ji ◽

Kathryn Sandberg

Keyword(s):

Cardiovascular Disease ◽

Caloric Restriction ◽

Heart Function ◽

Left Ventricular ◽

Structure And Function ◽

Long Term Effects ◽

Isolated Hearts ◽

Ad Libitum ◽

And Function

Severe caloric restriction (sCR) increases the risk for acute cardiovascular disease. Less understood are the long-term effects on cardiovascular disease risk after the sCR period has ended. We investigated the effects of sCR on heart structure and function months after refeeding (sCR-Refed). Female Fischer rats (3-months-old) were maintained on (CT) ad libitum or a 60% caloric restricted diet for 2 weeks. Thereafter, all rats received ad libitum chow for 3 months and they were analyzed by precision ultrasound to assess their heart function. After imaging, the animals were sacrificed and the hearts were subjected to ischemia-reperfusion (I/R) using a Langendorff preparation. After 2 weeks of sCR, rats lost 15% of their initial body weight (BW) [% (100*(Final-Initial/Initial)): CT, 1.5±0.8 vs sCR, -15.4±1.1; p<0.001;n=8]. After 3 months of refeeding, there was no detectable difference in BW between CT and sFR-Refed groups. Isolated hearts from the sCR-Refed rats exhibited worse myocardial pathology after I/R compared to CT rats. The parallel orientation of myofibers and striations normally present in cardiomyocytes was lost in sCR-Refed rats. Further analysis revealed uneven blood-filling of the microcirculatory vessels and prominent interstitial edema of the myocardium. Hearts from sCR-Refed rats had more atrophied cardiomyocytes than CT [Atrophied/Total (%): CT, 0.2±0.1 vs sCR-Refed, 50.6±1.1; p<0.001; n=5]. The number of arrhythmic events during a 30 min ischemic interval in isolated hearts doubled after 2 weeks on the sCR diet ( data not shown ) and remained doubled 3 months later [Arrhythmias (% of time): CT, 34±8 vs sCR-Refed, 68±9; p=0.02; n=8]. Ultrasound imaging showed no difference in stroke volume, coronary perfusion pressure and left ventricular mass. However, the thickness of the left ventricular posterior wall was significantly reduced in sCR-Refed rats [(mm): CT, 2.55 ±0.03 vs sCR-Refed, 2.10±0.04; p=0.002; n=4]. These findings indicate heart structure and function remained damaged months after the sCR period ended and BW was restored. These studies have adverse cardiovascular risk implications for who are subjected either voluntarily (crash diets) or involuntarily (very low food security) to periods of inadequate caloric intake.

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