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What an endocrinologist should know for patients receiving lithium therapy
Magalie Haissaguerre1, Marie-Christine Vantyghem2
1Service d'endocrinologie, CHU de Bordeaux, 33000 Bordeaux, France.
Annales D'Endocrinologie
|January 25, 2022
Summary
Lithium effectively treats bipolar disorder but can cause endocrine side effects like thyroid issues and hyperparathyroidism. Regular monitoring of thyroid function, calcium, and kidney health is crucial for patients on lithium therapy.
Area of Science:
- Endocrinology
- Pharmacology
- Nephrology
Background:
- Lithium is a primary treatment for bipolar disorder.
- Endocrine and renal side effects are significant concerns with lithium therapy.
- These side effects include thyroid dysfunction, hypercalcemia, and nephrogenic diabetes insipidus.
Purpose of the Study:
- To review the endocrine and renal side effects of lithium treatment.
- To highlight the prevalence and clinical presentation of these adverse effects.
- To emphasize the importance of monitoring and risk-benefit assessment.
Main Methods:
- Literature review of endocrine and renal side effects associated with lithium.
- Analysis of reported prevalence rates and clinical manifestations.
- Discussion of diagnostic considerations and management strategies.
Main Results:
- Lithium inhibits thyroid hormone secretion, increasing goiter prevalence and hypothyroidism risk.
- Lithium stimulates parathyroid cell proliferation, leading to a 4-6 fold increased risk of primary hyperparathyroidism.
- Nephrogenic diabetes insipidus is a frequent, potentially irreversible side effect, especially in patients with chronic kidney disease.
Conclusions:
- Clinical assessment of goiter and diuresis, alongside biological monitoring (serum calcium, sodium, creatinine, TSH, lithium levels), is recommended.
- The decision to discontinue lithium due to side effects must be carefully weighed against the psychological risks and discussed with a psychiatrist.
- Early detection and management of lithium-induced endocrine and renal complications are essential for patient safety.
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