Evaluation of thyroid function monitoring in people treated with lithium: Advice based on real‐world data

• Published in: Bipolar disorders Vol. 25; no. 5; pp. 402 - 409
• Main Authors: Duce, Helen L., Duff, Christopher J., Zaidi, Syed, Parfitt, Ceri, Heald, Adrian H., Fryer, Anthony A.
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.08.2023
• Subjects: Bipolar Disorder - chemically induced; Bipolar Disorder - drug therapy; Humans; Hypothyroidism; Hypothyroidism - drug therapy; interval; Lithium; Lithium - therapeutic use; monitoring; Patients; thyroid; Thyroid Diseases; Thyroid gland; Thyroid-stimulating hormone; Thyrotropin; Thyroxine; lithium; interval; thyroid; monitoring
• ISSN: 1398-5647; 1399-5618
• DOI: 10.1111/bdi.13298

Introduction Blood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance recommends 6‐monthly serum testing of thyroid function. We examined conformity to these guidelines and the impact of monitoring outside these intervals. Methods We extracted serum lithium and thyroid hormone results at one centre between January 2009 and December 2020. We identified 266 patients who started lithium during this period with no history of thyroid abnormality within the previous 2 years and were at risk of developing thyroid abnormalities. We examined the interval between tests, time between onset of lithium testing and first thyroid‐stimulating hormone (TSH) outside the laboratory reference range and assessed impact of testing outside recommended 6‐monthly intervals. Results The most common testing frequency was 3 months (±1 month), accounting for 17.3% of test intervals. Kaplan‐Meier analysis showed that most thyroid dysfunction manifests within 3 years (proportion with abnormal TSH at 3 years = 91.4%, 19.9% of total patients). In the first 3 months after commencing lithium therapy, eight patients developed subclinical hypothyroidism and had clinical follow‐up data available. Of these, half spontaneously normalized without clinical intervention. In the remaining patients, thyroxine replacement was only initiated after multiple occasions of subclinical hypothyroidism (median = 2 years after initiating lithium, range: 6 months to 3 years). Conclusion The peak interval at 3 months suggests that thyroid function is frequently checked at the same time as serum lithium, indicating too frequent testing. Our data support the recommended 6‐monthly testing interval and highlight poor adherence to it.