Lithiumogenic Disorders of the Thyroid and Parathyroid Glands as Surgical Disease
| Title: | Lithiumogenic Disorders of the Thyroid and Parathyroid Glands as Surgical Disease |
|---|---|
| Authors: | McHenry, Christopher R.; Rosen, Irving B.; Rotstein, Lorne E.; Forbath, Nicholas; Walfish, Paul G. |
| Publisher: | Surgery |
| Date Published: | December 01, 1990 |
| Reference Number: | 332 |
Little notice has been paid in the surgical literature to problems with psychoeffective lithium, which by interfering with adenylate cyclase affects thyroid and parathyroid function, causing hypercalcemia, hyperparathyroidism, and hypothyroidism. Seven patients with lithiumogenic hyperparathyroidism occurring after years of lithium therapy underwent treatment and manifested osteoporosis (n = 2), hypertension (n = 2), nephrolithiasis (n = 1), coma (n = 1), rising hypercalcemia (n = 1), goitrous myxedema (n = 4), nephrogenic diabetes insipidus (n = 2), renal failure (n = 2), and hyperlipidemia (n = 1). Disease-directed parathyroidectomy (without morbidity) was curative. Unique laboratory findings included normal serum phosphorus and reduced urinary calcium and cyclic adenosine monophosphate values. Three separate cases of thyroid carcinoma after long-term lithium therapy were also treated, being preceded by myxedema (n = 2) and concurrent with hyperparathyroidism (n = 1). There has been only one previous report of lithium-associated thyroid carcinoma. All patients taking lithium should undergo surveillance for thyroid and parathyroid dysfunction and neoplasia, and appropriate surgical and medical treatment should be considered in each situation. Although hyperparathyroidism may be reversible with lithium discontinuance, such therapy may be obligatory for patient well-being, thus dictating parathyroidectomy.
This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
© Copyright NDI Foundation 2007 (JC)
Seven of the patients experienced lithium-induced hyperparathyroidism. This was associated with some of the seven developing: osteoporosis (2), hypertension (2), hypercalcemic coma (1) progression of psychopathology (1), nephrolithiasis (1), nephrogenic diabetes insipidus (2), kidney impairment (2), hypothyroidism (4) and hyperlipidemia (1). These patients had their parathyroid gland surgically removed, and they experienced improvement as a result.
The authors also report on three cases of thyroid carcinoma occurring in association with long-term lithium therapy. All three had almost all their thyroid gland surgically removed.
Given the seriousness of lithium-induced complications of the thyroid and parathyroid glands, the authors recommend that all patients considering lithium therapy should have base-line measurements of their thyroid function, serum calcium, creatine, and parathormone levels. People on lithium therapy should undergo routine laboratory surveillance and regular physical examinations of the neck for as long as they are taking lithium. In addition, all patients on lithium therapy should be regularly checked for thyroid and parathyroid dysfunction and neoplasia.