Lithium endocrine

Lithium Neurological tremor, ataxia, seizures Endocrine hypothyroidism Cardiovascular T wave changes, sinus node dysfunction Renal polyuria, nephrogenic diabetic insipidus Dermatological hair loss, acne, psoriasis, rash Gastrointestinal nausea, diarrhea Miscellaneous fluid retention, weight gain, weakness... 

Lithium has several effects on the endocrine system. For example, it can interfere with the synthesis and the release of testosterone, leading to an increase in luteinizing hormone levels. The thyroid system has been most implicated in neuroendocrine theories of lithium s antimanic effects. In particular, thyroid hormones can potentiate b-NE activity, and lithium s ability to block their release may subserve its mood-stabilizing properties (i.e., the thyroid-catecholamine receptor hypothesis)... 

Whereas iithium has been the standard approach, increased complications in elderly patients, especially when there is compromise of the CNS, endocrine, or renal systems, makes this agent a less attractive choice. Lower doses (e.g., 150 to 300 mg) should be initiated, with many elderly patients achieving adequate response on total daily doses of lithium in the 450- to 600-mg range. If a more rapid response is necessary, low-dose high-potency antipsychotics can also be used in the early phases. Alternatively, a BZD, such as clonazepam or lorazepam, may be indicated (297). 

Bschor T, Lewitzka U, Sasse J, et al. Lithium augmentation in treatment-resistant depression clinical evidence, serotonergic and endocrine mechanisms. Pharmacopsychiatry. 2003 36(suppl 3) S230—S234. 

Lazarus, J. H. Collard, K. J. Endocrine and Metabolic Effects of Lithium, Plenum, New York, 1986. 

Baptista T, Lacruz A, de Mendoza S, Guillen MM, Burguera JL, de Burguera M, Hernandez L. Endocrine effects of lithium carbonate in healthy premenopausal women relationship with body weight regulation. Prog Neuropsychopharmacol Biol Psychiatry 2000 24(1) 1-16. 

Shen F-EI, Sherrad DJ. Lithium-induced hyperparathyroidism an alteration of the "set-point". Ann Int Med 1982 96(1) 63-65. Eladen ST, Brown EM, Stoll AL, Scott J, El-Elajj F, Ghada.The effect of lithium on calcium-induced changes in adrenocorticotrophin levels. J Clin Endocrin Met 1999 84(1) 198-200. 

Lazarus JFi. Endocrine and metabolic effects of lithium. New York Plenum Medical, 1986. 

Studies in endocrine organs showed accumulation of lithium in both thyroid and pituitary glands in chronically treated rats [25]. Epithelial cell height is reduced in thyroid gland in cells from lithium patients [26] and from rats [27]. 

Endocrine Thyroid Thyroid abnormalities are common during lithium treatment 20% develop hypothyroidism and 40% develop goiter if untreated [33 ]. In one study of elderly people (over 65 years old) taking lithium (n=79), 28 were hypothyroid [34 ]. This compares with a rate of only 7.1% of a matched non-lithium-treated control group (n = 85), a rate that is similar to that of the general population. This effect is not mediated by production of antithyroid antibodies, since antibodies were present in 27% of the patients who were tested, a rate that is similar to that in non-lithium-treated patients in this age group. The lack of association with antithyroid antibodies in lithium-related thyroid dysfunction is true for all age groups [35 j. 

Endocrine Thyroid A woman with thyroid carcinoma who was taking lithium for bipolar disorder discontinued her thyroid hormone replacement in preparation for radioactive iodine ( I) treatment [59" ]. Within 3 weeks she developed severe lithium toxicity, which the authors attributed to renal insuffidenqr associated with hypothyroidism [60 ]. Lithium was not withdrawn in this patient, because of an earlier suggestion that lithium can be used as an adjunct in treatment [61 ]. In an in vitro study using follicular thyroid carcinoma cell lines, lithium 10-20 nunol/1 induced expression of NR4A1 and FOSB, genes whose underexpression is associated with mahgnancy [62 ]. 

I] Giusti CF, Amorim SR, Guerra RA, Portes ES. Endocrine disturbances related to the use of lithium. Arq Bras Endocrinol Metab 2012 56(3) 153-8. 

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