ENDOCRINE EFFECTS OF LITHIUM

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Abstract
The prevalence of hypothyroidism in a sample of Li-treated manic-depressive outpatients who were under treatment for several years was evaluated. The sample included 86 patients, 70 females and 16 males, who were treated for an average of 80 mo. Blood donors [105], 58 females and 47 males, aged 21-70 yr, served as a reference population for determinations of serum triiodothyronine (T3), thyroxine (T4), triiodothyronine-resin uptake (T3RU), the free T3 and T4 indices (FT3I and FT4I) and thyroid stimulating hormone (TSH). Raised TSH levels occurred in 20 patients (23%), all females who were over 40, except for one. This prevalence of 19 cases of hypothyroidism among 56 females over 40 yr of age (34%) contrasted sharply with 1 single case in the remaining 30 patients (P < 0.001). Highly significant reductions (P < 0.001) of FT3I and FT4I were observed in the 20 patients with raised TSH levels, in whom log TSH also correlated very closely with FT3I and FT4I (r [correlation coefficient] = - 0.73 and -0.86, respectively, P < 0.001). Remaining patients had average normal values of T4, FT4I and TSH, but slightly depressed levels of T3 (P < 0.05) and FT3I (P < 0.01), possibly reflecting decreased peripheral T4 deiodination. Apparently cases of hypothyroidism continue to appear as treatment continues, TSH determination is recommended at 6-12 mo. intervals in manic-depressive patients undergoing long-term Li therapy.

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