Incidence of hyperthyroidism in patients with bipolar or schizoaffective disorder with or without lithium: 21-year follow-up from the LiSIE retrospective cohort study.
Ingrid Lieber, Michael Ott, Robert Lundqvist, Mats Eliasson, Ursula Werneke
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引用次数: 2
Abstract
Background: Lithium-associated hyperthyroidism is much rarer than lithium-associated hypothyroidism. Yet, it may be of substantial clinical significance for affected individuals. For instance, lithium-associated hyperthyroidism could destabilise mood, mimic manic episodes and impact physical health. Only few studies have explored incidence rates of lithium-associated hyperthyroidism. Even fewer studies have compared incidence rates according to lithium exposure history.
Objectives: To determine the impact of lithium treatment on the incidence rate of hyperthyroidism in patients with bipolar or schizoaffective disorder and assess its aetiology.
Design: This study is part of the LiSIE (Lithium - Study into Effects and Side Effects) retrospective cohort study.
Methods: Between 1997 and 2017, patients in the Swedish region of Norrbotten with a diagnosis of bipolar or schizoaffective disorder were screened for all episodes of overt hyperthyroidism in form of thyrotoxicosis or thyroiditis. Incidence rates of episodes of hyperthyroidism per 1000 person-years (PY) were compared in relation to lithium exposure; concurrent, previous, or no exposure ever (lithium-naïve patients).
Results: In 1562 patients, we identified 16 episodes of hyperthyroidism corresponding to an incidence rate of 0.88 episodes per 1000 PY. Ninety-four percent of episodes had occurred in women. Patients who had concurrently been exposed to lithium, had an incidence rate of 1.35 episodes per 1000 PY. Patients who had previously been exposed to lithium had an incidence rate of 0.79 per 1000 PY. Patients who had never been exposed to lithium had an incidence rate of 0.47 per 1000 PY. There were no significant differences in the risk ratios for patients with concurrent or previous exposure compared with lithium-naïve patients, neither for hyperthyroidism overall, thyrotoxicosis, or thyroiditis.
Conclusion: Lithium-associated hyperthyroidism seems uncommon. The risk of hyperthyroidism does not seem significantly higher in patients with current or previous lithium exposure than in lithium-naïve patients.
背景:锂相关性甲状腺功能亢进比锂相关性甲状腺功能减退更罕见。然而,它可能对受影响的个体具有重要的临床意义。例如,锂相关的甲状腺功能亢进可能会破坏情绪稳定,模仿躁狂发作,影响身体健康。只有少数研究探讨了锂相关甲状腺功能亢进的发病率。更少的研究比较了锂暴露史的发病率。目的:探讨锂离子治疗对双相或分裂情感性障碍患者甲状腺功能亢进发生率的影响,并评估其病因。设计:本研究是LiSIE (Lithium - study into Effects and Side Effects)回顾性队列研究的一部分。方法:在1997年至2017年期间,对瑞典北博腾地区诊断为双相情感障碍或分裂情感障碍的患者进行筛查,以检查甲状腺毒症或甲状腺炎形式的所有显性甲状腺功能亢进发作。比较了每1000人年(PY)甲状腺功能亢进发作的发生率与锂暴露的关系;同时、既往或从未暴露(lithium-naïve患者)。结果:在1562例患者中,我们确定了16例甲状腺功能亢进,对应的发病率为每1000 PY 0.88例。94%的病例发生在女性身上。同时暴露于锂的患者的发病率为每1000 PY 1.35次。以前接触过锂的患者的发病率为0.79 / 1000 PY。从未接触过锂的患者的发病率为0.47 / 1000 PY。与lithium-naïve患者相比,同时或既往暴露的患者的风险比没有显著差异,无论是整体甲状腺功能亢进、甲状腺毒症还是甲状腺炎。结论:锂相关甲状腺功能亢进似乎并不常见。目前或既往锂暴露的患者甲状腺功能亢进的风险似乎并不明显高于lithium-naïve患者。
期刊介绍:
Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.