Evaluation of thyroid function monitoring in people treated with lithium: Advice based on real‐world data
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 interva...
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Published in | Bipolar disorders Vol. 25; no. 5; pp. 402 - 409 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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Abstract | 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. |
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AbstractList | INTRODUCTIONBlood 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. METHODSWe 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. RESULTSThe 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). CONCLUSIONThe 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. Abstract 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. 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. 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. 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. 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). 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. |
Author | Parfitt, Ceri Fryer, Anthony A. Duff, Christopher J. Heald, Adrian H. Duce, Helen L. Zaidi, Syed |
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Cites_doi | 10.1111/bdi.12681 10.1111/ijcp.14447 10.1111/bdi.12805 10.1186/s40345-016-0068-y 10.1016/S0140-6736(14)61842-0 10.1177/0269881118760663 10.1177/0269881119882858 10.1192/bjo.2021.1027 10.1016/j.jad.2015.04.055 10.1186/s12888-020-03023-y 10.1055/s-0043-103018 10.1007/BF03346311 10.1373/clinchem.2011.176487 10.1186/1756-6614-6-3 10.1111/ijcp.13277 |
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Copyright | 2023 The Authors. published by John Wiley & Sons Ltd. 2023 The Authors. Bipolar Disorders published by John Wiley & Sons Ltd. 2023. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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Snippet | Introduction
Blood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance... Blood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance recommends 6-monthly... Abstract Introduction Blood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance... IntroductionBlood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance... INTRODUCTIONBlood test monitoring is essential for the management of lithium treatment and National Institute for Health and Care Excellence guidance... |
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SubjectTerms | 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 |
Title | Evaluation of thyroid function monitoring in people treated with lithium: Advice based on real‐world data |
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