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Elevated Thyroxine Concentration and Lithium Intoxication-An Analysis Based on the LiSIE Retrospective Cohort Study
Ingrid Lieber1, Michael Ott2, Robert Lundqvist3
1Sunderby Research Unit, Department of Clinical Sciences, Psychiatry, Umeå University, 90185 Umeå, Sweden.
Journal of Clinical Medicine
|June 10, 2022
Summary
Hyperthyroxinaemia is rarely linked to lithium intoxication in bipolar disorder patients. The study found no direct causal relationship, suggesting routine thyroid monitoring may not prevent lithium toxicity.
Area of Science:
- Psychiatry
- Nephrology
- Endocrinology
Background:
- Hyperthyroxinaemia (high thyroid hormone levels) is hypothesized to increase lithium intoxication risk.
- This risk is thought to be mediated by altered kidney tubular function.
Purpose of the Study:
- To investigate the association between hyperthyroxinaemia and unintentional lithium intoxication.
- To assess the role of thyroid function in lithium toxicity risk among patients with bipolar or schizoaffective disorder.
Main Methods:
- Retrospective cohort study (LiSIE study) of 1562 patients.
- Analysis of 897 lithium-exposed patients over 6684 person-years.
- Examination of episodes of unintentional lithium intoxication and co-occurring hyperthyroxinaemia.
Main Results:
- 65 episodes of lithium intoxication occurred in 53 patients.
- Nine episodes (1.3/1000 person-years) were associated with hyperthyroxinaemia.
- Alternative explanations were identified for all hyperthyroxinaemia-associated intoxications.
Conclusions:
- Hyperthyroxinaemia-associated lithium intoxication is uncommon.
- A direct causal link between hyperthyroxinaemia and altered renal tubular function in lithium intoxication is not established.
- Increased frequency of thyroid function tests is unlikely to reduce lithium intoxication risk.
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