Kraszewska Agnieszka, Abramowicz Maria, Chłopocka-Woźniak Maria, Sowiński Jerzy, Rybakowski Janusz
Psychiatr Pol. 2014 May-Jun;48(3):417-28.
Since 1963 lithium treatment has been the best proven long-term pharmacotherapy for bipolar disorder (BD), both in the prevention of depressive and manic episodes, along with the reduction of the suicide risk. Thyroid gland and the hypothalamic-pituitary-thyroid (HPT) axis play a role in the pathophysiology, clinical course and treatment of BD. The influence of lithium on the thyroid gland is one of the key side effects in the long-term therapy with this drug. Lithium is accumulated in the thyroid gland at 3 to 4-fold higher concentrations as compared to its plasma levels. Its administration results in the reduced production with release inhibition of thyroid hormones, altering the immune processes of this gland. The most common thyroid side effects associated with long-term lithium treatment are goiter and hypothyroidism. Hyperthyroidism is a rare complication of lithium therapy. Lithium may also induce an increase in the thyroid autoimmunity, especially if such change had been present before lithium treatment producing structural changes in this gland. This paper reviews the management of complications described above as well as recommendations for monitoring of thyroid function in patients receiving long-term lithium treatment are discussed.
自1963年以来，锂盐治疗一直是双相情感障碍（BD）经充分验证的最佳长期药物治疗方法，可预防抑郁和躁狂发作，并降低自杀风险。甲状腺及下丘脑-垂体-甲状腺（HPT）轴在双相情感障碍的病理生理学、临床病程及治疗中发挥作用。锂盐对甲状腺的影响是该药物长期治疗的关键副作用之一。锂盐在甲状腺中的蓄积浓度比其血浆浓度高3至4倍。其给药会导致甲状腺激素生成减少并抑制释放，改变该腺体的免疫过程。长期锂盐治疗最常见的甲状腺副作用是甲状腺肿和甲状腺功能减退。甲状腺功能亢进是锂盐治疗的罕见并发症。锂盐还可能导致甲状腺自身免疫性增加，尤其是在锂盐治疗前就存在这种变化并导致该腺体结构改变的情况下。本文综述了上述并发症的处理方法，并讨论了接受长期锂盐治疗患者甲状腺功能监测的建议。
