Long-term lithium treatment and thyroid antibodies: a controlled study

Long-term lithium treatment and thyroid antibodies: a controlled study

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J Psychiatry Neurosci 2005;30(6):423-7

Christopher Baethge, MD; Holger Blumentritt, MD, MPH; Anne Berghöfer, MD; Tom Bschor, MD; Tasha Glenn, PhD; Mazda Adli, MD; Peter Schlattmann, MD; Michael Bauer, MD, PhD; Reinhard Finke, MD

Baethge — Department of Psychiatry, Bipolar and Psychotic Disorders Program, Harvard Medical School, McLean Division of Massachusetts General Hospital, Belmont, Mass.; and Department of Psychiatry, University of Cologne, Cologne, Germany; Blumentritt — Department of Hematology, Paul-Ehrlich-Institute, Langen, Germany; Berghöfer — Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medicine Berlin, Berlin, Germany; Bschor — Department of Psychiatry, Carl Gustav Carus Hospital, Technische Universität Dresden, Dresden, Germany; Schlattmann — Institute for Medical Informatics, Epidemiology and Biometry, Charité, Freie Universität Berlin, Berlin, Germany; Adli, Bauer — Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Berlin, Germany; Finke — Benjamin Franklin University Hospital, Berlin, Germany; Baethge, Berghöfer, Bschor, Glenn, Bauer — The International Group for the Study of Lithium Treated Patients (IGSLI); Glenn — ChronoRecord Association, Inc., Fullerton, Calif.

Abstract

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.

Résumé

Objectif : Comme le rôle de l’auto-immunité thyroïdienne dans l’apparition d’une dysfonction thyroïdienne causée par le lithium suscite toujours la controverse, nous avons comparé la prévalence d’autoanticorps thyroïdiens chez des patients qui ont des troubles de l’affectivité et qui suivent une thérapie d’entretien de longue durée au lithium à ce qui se passe chez des témoins jumelés selon l’âge et le sexe.

Méthodes : Nous avons effectué une étude transversale portant sur 100 patients adultes atteints de troubles majeurs de l’affectivité diagnostiqués conformément à la version révisée du Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), qui suivaient une thérapie au lithium pendant six mois ou plus à une clinique universitaire spécialisée, et sur 100 témoins jumelés selon l’âge et le sexe qui n’avaient aucun antécédent de troubles psychiatriques de l’axe I. On a mesuré les autoanticorps sériques contre la thyroïde peroxydase (TPOAb), la thyroglobuline (TgAb) et les récepteurs de la TSH (TRAb).

Résultats : On a constaté la présence de TPOAb chez sept patients et 11 témoins et de TgAb chez huit patients et 15 témoins. On n’a pas trouvé de TRAb chez aucun sujet des deux groupes.

Conclusions : Dans cet échantillon de patients qui ont des troubles de l’affectivité, le traitement de longue durée au lithium n’a pas augmenté la prévalence de l’auto-immunité thyroïdienne.


Medical subject headings: hypothyroidism; lithium; mood disorders; thyroid antibodies.

Submitted Dec. 21, 2004; Revised Aug. 16, 2005; Accepted Aug. 29, 2005

Acknowledgements: This study was supported, in part, by the Max Kade Foundation, New York City, NY (C.B.). We would like to thank Pharmacia/Upjohn Diagnostics, Freiburg, and Brahms Diagnostika GmbH, Berlin, for providing antibody kits for this study at no cost.

Competing interests: None declared for Drs. Baethge, Blumentritt, Bschor, Glenn, Adli and Schlattman. Dr. Berghöfer has received speaker fees from GlaxoSmithKline, Pfizer, Sanofi-Synthelabo (Aventis) and Eli Lilly. Dr. Bauer has received speaker fees from GlaxoSmithKline. Dr. Finke has received speaker fees from Sanofi-Aventis, Novartis and Pfizer and travel assistance from Novartis, Pfizer and Ipson.

Contributors: Drs. Bschor and Bauer contributed to the conception and design of the study. Drs. Baethge, Blumentritt, Berghöfer, Adli and Finke contributed to the acquisition of data. Drs. Baethge, Glenn, Schlattmann and Finke contributed to the analysis and interpretation of the data. Drs. Baethge, Glenn and Schlattman contributed to drafting and reviewing the article. Drs. Blumentritt, Berghöfer, Bschor, Adli, Bauer and Finke contributed to reviewing the article critically. All authors gave final approval for the article to be published.

Correspondence to: Dr. Michael Bauer, Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Charité Mitte (CCM), Schumannstrasse 20/21, 10117 Berlin, Germany; fax 49 30 450 51 70 62; michael.bauer@charite.de