Lithium Doubles Threat of Thyroid and Kidney Dysfunction

In a brand new research, researchers discovered that even short-term lithium use doubled the chance of hypothyroidism, hyperthyroidism, and power kidney illness. The research targeted on sufferers with a bipolar dysfunction prognosis in Hong Kong.

Greater lithium ranges have been related to the next danger for thyroid and kidney issues, however the elevated danger nonetheless confirmed up at serum lithium ranges decrease than these beneficial by therapy pointers. Based on the researchers, pointers counsel lithium ranges of 0.60 to 0.80 mEq/L. Nonetheless, the elevated danger for hypothyroidism, hyperthyroidism, and power kidney illness confirmed up at 0.50 to 0.58 mEq/L.

“These information can present essential empirical proof that may inform scientific pointers on figuring out optimum vary of lithium serum ranges, balancing therapy efficacy and security, and selling customized therapy for BD, notably in Asian populations,” the researchers write.

The research was led by Joe Kwun Nam Chan and Wing Chung Chang on the College of Hong Kong. It was printed in JAMA Community Open.

The present research was a population-based cohort research with information from digital well being data in Hong Kong. The researchers included all sufferers at the very least 15 years outdated who acquired their first bipolar prognosis between 2002 and 2018. The researchers then in contrast those that have been prescribed lithium to those that weren’t. The researchers additionally stratified the lithium degree, when potential, so they might analyze whether or not these taking larger doses have been at elevated danger.

The outcomes of curiosity have been hypothyroidism, hyperthyroidism, power kidney illness (CKD; stratified into CKD3+ and the extra extreme CKD4+), and end-stage kidney illness (ESKD). In whole, 4752 sufferers have been assessed for hypothyroidism, 4500 for hyperthyroidism, and 7029 for CKD.

The researchers discovered that these taking lithium have been at twice the chance of hypothyroidism (adjusted hazard ratio [aHR] 2.00) and 35% elevated danger of CKD (aHR 1.35).

These with larger serum lithium ranges have been at larger danger: aHR 2.08 for hypothyroidism, aHR 1.81 for hyperthyroidism, and aHR 2.11 for CKD.

Those that skilled extra episodes of lithium toxicity have been additionally at elevated danger of growing CKD.

The researchers accounted for quite a lot of potential confounding elements: “A complete array of covariates was included within the analyses, comprising affected person demographics, pre-existing bodily comorbidities, substance and alcohol use problems, use of different psychotropics, and use of medicines with nephrotoxic danger when interacting with lithium,” they write.

The researchers in contrast these taking lithium to these taking particular different medication, and write that “valproate, olanzapine, quetiapine, and risperidone usually exhibited lowered probability of thyroid dysfunction and CKD3+ in contrast with lithium, with none distinction in superior CKD.” Nonetheless, these medication have their very own checklist of dangerous results.

They didn’t discover an affiliation between lithium use and extra extreme kidney issues (CKD4+ and ESKD). Nonetheless, they notice that the comparatively brief period of use they discovered within the research (on common, about 8.5 years) might not have been lengthy sufficient for them to see the kidney issues to progress to this stage. They write that it could be 10 to twenty years earlier than kidney illness progresses to this degree of severity.

One other odd discovering: the researchers didn’t discover longer-term use of lithium to be related to elevated danger for thyroid or kidney issues, regardless of earlier analysis discovering that longer-term use will increase the chance. One rationalization, in accordance with the researchers, is that their discovering is because of reverse causality—those that had early indicators of those well being issues might need stopped taking lithium. In spite of everything, greater than half of those that begin taking lithium discontinue it as a result of antagonistic results.

Lithium is taken into account probably the most harmful medication in psychiatry’s armamentarium, with a variety for toxicity that overlaps the supposed therapeutic vary. Sufferers have to be fastidiously monitored, as lithium toxicity may trigger everlasting mind injury.

Earlier research have discovered a excessive danger of power kidney illness and different illnesses after lithium use. For example, one research discovered that lithium use was related to a sixfold improve in hypothyroidism. Different researchers have famous that 20% of sufferers develop nephrogenic diabetes insipidus, and that the kidney injury may be irreversible even when sufferers cease taking the drug.

Nonetheless, some psychiatrists, equivalent to Nassir Ghaemi, tout its psychological well being advantages, even whereas acknowledging that different psychiatric medication fail to stay as much as expectations. And a few researchers have even known as for including lithium to consuming water, arguing that it’ll cut back suicide charges at a inhabitants degree.

However trials of lithium don’t help its anti-suicidal properties. In 2021, a research on veterans was terminated early as a result of the drug didn’t enhance suicide-related occasions in contrast with a placebo. Equally, a 2022 meta-analysis additionally discovered no proof that lithium prevented suicide-related occasions.

Furthermore, lithium in consuming water additionally has harmful properties. A 2023 research in JAMA Pediatrics discovered that moms who have been uncovered to excessive ranges of lithium in consuming water whereas pregnant have been 46% extra more likely to have a child with an autism prognosis. Excessive lithium ranges throughout being pregnant have additionally been related to an elevated danger of spontaneous abortion, congenital anomalies, and cardiovascular issues in offspring.

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Chan, J. Ok. N., Solmi, M., Correll, C. U., Wong, C. S. M., Lo, H. Ok. Y., Lai, F. T. T., & Chang, W. C. (2025). Lithium for bipolar dysfunction and danger of thyroid dysfunction and power kidney illness. JAMA Community Open, 8(2), e2458608. doi:10.1001/jamanetworkopen.2024.58608 (Hyperlink)