Abstract
Background
There is debate whether patients with rapid-cycling bipolar disorder (BD) are predisposed
to thyroid axis abnormalities and whether this may contribute to development of rapid
mood shifts. Using lithium carbonate as a challenge to the hypothalamic-pituitary-thyroid
(HPT) system, we determined whether patients with rapid-cycling BD are sensitive to
the “antithyroid” properties of lithium.
Methods
We studied the response to thyrotropin-releasing hormone (TRH) of HPT system hormones
in 20 medication-free patients with rapid-cycling BD and compared these measurements
with those of 20 healthy age- and gender-matched control subjects. The same measurements
were repeated after both groups had received lithium carbonate for 4 weeks in sufficient
doses to maintain blood levels between .7–1.2 mEq/L.
Results
At baseline, the results of thyroid function tests, including the TRH challenge test,
did not differ between patients and control subjects. After treatment with lithium,
serum concentrations of thyroxine significantly decreased, whereas basal thyrotropin
(TSH) and ΔTSHmax significantly increased in both patients and control subjects; however, patients
had significantly higher ΔTSHmax after TRH stimulation. More patients than control subjects developed laboratory evidence
consistent with grade III hypothyroidism after lithium treatment.
Conclusions
Rapid-cycling BD is associated with a latent hypofunction of the HPT system. This
dysfunction becomes manifest with short-term lithium challenge.
Keywords
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Article info
Publication history
Accepted:
August 2,
2002
Received in revised form:
July 23,
2002
Received:
February 11,
2002
Identification
Copyright
© 2003 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
