리튬을 사용한 병력이 없는 양극성장애 환자에서의 갑상선기능저하증
Hypothyroidism of Lithium - Naïve Patients with Bipolar Disorders
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Objectives：Hypothyroidism is highly reported in bipolar patients. However it is controversial that the cause of hypothyroidism in bipolar patients is lithium or affective disorder itself. This study aims to exam the prevalence of hypothyroidism in lithium naïve bipolar patients and also to exam the predictor of hypothyroidism in lithium naïve bipolar patients. Methods：We retrospectively reviewed medical charts of 394 bipolar patients who visited Psychiatric Outpatient clinic of Ulsan university hospital between March 1, 2011 and February 28, 2013 and have never been exposed to lithium before they visit the clinic. Sex, age, number of previous episode, duration of illness, bipolar diagnostic subtype, rapid cycling pattern, Free T4 and TSH levels at first visit was evaluated from charts. Results：The proportion of total thyroid abnormality was 50(12.7%). Among them hypothyroidism was 29(7.4%). There are no differences between different sex, age distribution, duration of illness, number of previous episode, rapid cycling and diagnostic subtypes. There is no demographic and clinical variable which predict hypothyroidism in bipolar patients significantly. Conclusion：Lithium may contributed as a confounding variable to the hypothyroidism in bipolar patients. Our data do not support the previous finding of higher rate of hypothyroidism in female and rapid cycling bipolar patients. Further study is necessary to explore the relationship between lithium associated hypothyroidism and various demographic and clinical variables.
Abstract
Objectives：Hypothyroidism is highly reported in bipolar patients. However it is controversial that the cause of hypothyroidism in bipolar patients is lithium or affective disorder itself. This study aims to exam the prevalence of hypothyroidism in lithium naïve bipolar patients and also to exam the predictor of hypothyroidism in lithium naïve bipolar patients. Methods：We retrospectively reviewed medical charts of 394 bipolar patients who visited Psychiatric Outpatient clinic of Ulsan university hospital between March 1, 2011 and February 28, 2013 and have never been exposed to lithium before they visit the clinic. Sex, age, number of previous episode, duration of illness, bipolar diagnostic subtype, rapid cycling pattern, Free T4 and TSH levels at first visit was evaluated from charts. Results：The proportion of total thyroid abnormality was 50(12.7%). Among them hypothyroidism was 29(7.4%). There are no differences between different sex, age distribution, duration of illness, number of previous episode, rapid cycling and diagnostic subtypes. There is no demographic and clinical variable which predict hypothyroidism in bipolar patients significantly. Conclusion：Lithium may contributed as a confounding variable to the hypothyroidism in bipolar patients. Our data do not support the previous finding of higher rate of hypothyroidism in female and rapid cycling bipolar patients. Further study is necessary to explore the relationship between lithium associated hypothyroidism and various demographic and clinical variables.
참고문헌 (31)
- Cowdry RW, "Thyroid abnormalities associated with rapid-cycling bipolar illness", Arch Gen Psychiatry, 40, pp.414~420 (1983)
- Bocchetta A, "Thyroid abnormalities during lithium treatment", Acta Psychiatr Scand, 83, pp.193~198 (1991)
- Joffe RT, "Thyroid function and bipolar affective disorder", Psychiatry Res, 25, pp.117~121 (1988)
- Wehr TA, "Rapid cycling affective disorder: contributing factors and treatment responses in 51 patients", Am J Psychiatry, 145, pp.179~184 (1988)
- Baumgartner A, "The hypothalamic-pituitarythyroid axis in patients maintained on lithium prophylaxis for years: high triiodothyronine serum concentrations are correlated to the prophylactic efficacy", J Affect Disord, 34, pp.211~218 (1995)
- Lombardi G, "Effects of lithium treatment on hypothalamic-pituitary-thyroid axis: a longitudinal study", J Endocrinol Invest, 16, pp.259~263 (1993)
- Kleiner J, "Lithium-induced subclinical hypothyroidism: review of the literature and guidelines for treatment", J Clin Psychiatry, 60, pp.249~255 (1999)
- Perrild H, "Thyroid function and ultrasonically determined thyroid size in patients receiving long-term lithium treatment", Am J Psychiatry, 147, pp.1518~1521 (1990)
- Kupka RW, "High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure", Biol Psychiatry, 51, pp.305~311 (2002)
- Dunner DL, "Heritable factors in the severity of affective illness", Biol Psychiatry, 11, pp.31~42 (1976)
- Leckman JF, "Reduced MAO activity in first-degree relatives of individuals with bipolar affective disorders. A preliminary report", Arch Gen Psychiatry, 34, pp.601~606 (1977)
- Canaris GJ, "The Colorado thyroid disease prevalence study", Arch Intern Med, 160, pp.526~534 (2000)
- Bartalena L, "Evaluation of thyroid function in patients with rapid-cycling and non-rapid-cycling bipolar disorder", Psychiatry Res, 34, pp.13~17 (1990)
- Kupka RW, "Rapid and non-rapid cycling bipolar disorder:a meta-analysis of clinical studies", J Clin Psychiatry, 64, pp.1483~1494 (2003)
- Vincent A, "Early onset of lithiumassociated hypothyroidism", J Psychiatry Neurosci, 18, pp.74~77 (1993)
- Valle J, "Evaluation of thyroid function in lithium-naive bipolar patients", Eur Psychiatry, 14, pp.341~345 (1999)
- Bauer MS, "Rapid cycling bipolar affective disorder. I. Association with grade I hypothyroidism", Arch Gen Psychiatry, 47, pp.427~432 (1990)
- Association AP, "Diagnostic and statistical manual of mental disorders" (2000), DSM-IV-TR®: American Psychiatric Association
- Dunner DL, "Clinical factors in lithium carbonate prophylaxis failure", Arch Gen Psychiatry, 30, pp.229~233 (1974)
- Aoki Y, "Serum TSH and total T4 in the United States population and their association with participant characteristics: National Health and Nutrition Examination Survey(NHANES 1999-2002)", Thyroid, 17, pp.1211~1223 (2007)
- Wenzel KW, "Classification of hypothyroidism in evaluating patients after radioiodine therapy by serum cholesterol, T3-uptake. Total T4, FT4-index, total T3, basal TSH and TRH-test", Eur J Clin Invest, 4, pp.141~148 (1974)
- Choi HS, "Prevalence of subclinical hypothyroidism in two population based-cohort: Ansung and KLoSHA Cohort in Korea", J Korean Thyroid Assoc, 3, pp.32~40 (2010)
- Zhang ZJ, "Differences in hypothyroidism between lithium-free and -treated patients with bipolar disorders", Life Sci, 78, pp.771~776 (2006)
- Goodwin FK, "Cerebrospinal fluid amine metabolites in affective illness:the probenecid technique", Am J Psychiatry, 130, pp.73~79 (1973)
- Schatzberg AF, "Toward a biochemical classification of depressive disorders. X. Urinary catecholamines, their metabolites, and D-type scores in subgroups of depressive disorders", Arch Gen Psychiatry, 46, pp.260~268 (1989)
- Johnston AM, "Lithium-associated clinical hypothyroidism. Prevalence and risk factors", Br J Psychiatry, 175, pp.336~339 (1999)
- Cassidy F, "Thyroid function in mixed and pure manic episodes", Bipolar Disord, 4, pp.393~397 (2002)
- Kramlinger KG, "Addition of lithium carbonate to carbamazepine: hematological and thyroid effects", Am J Psychiatry, 147, pp.615~620 (1990)
- Roy-Byrne P, "Relationship of response to sleep deprivation and carbamazepine in depressed patients", Acta Psychiatr Scand, 69, pp.379~382 (1984)
- Baumgartner A, "Effects of lithium and carbamazepine on thyroid hormone metabolism in rat brain", Neuropsychopharmacology, 16, pp.25~41 (1997)
- Herman R, "The effects of carbamazepine on resting metabolic rate and thyroid function in depressed patients", Biol Psychiatry, 29, pp.779~788 (1991)