Lambert Christophe G, Mazurie Aurélien J, Lauve Nicolas R, Hurwitz Nathaniel G, Young S Stanley, Obenchain Robert L, Hengartner Nicolas W, Perkins Douglas J, Tohen Mauricio, Kerner Berit
Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Bipolar Disord. 2016 May;18(3):247-60. doi: 10.1111/bdi.12391.
Thyroid abnormalities in patients with bipolar disorder (BD) have been linked to lithium treatment for decades, yet other drugs have been less well studied. Our objective was to compare hypothyroidism risk for lithium versus the anticonvulsants and second-generation antipsychotics commonly prescribed for BD.
Administrative claims data on 24,574 patients with BD were analyzed with competing risk survival analysis. Inclusion criteria were (i) one year of no prior hypothyroid diagnosis nor BD drug treatment, (ii) followed by at least one thyroid test during BD monotherapy on lithium carbonate, mood-stabilizing anticonvulsants (lamotrigine, valproate, oxcarbazepine, or carbamazepine) or antipsychotics (aripiprazole, olanzapine, risperidone, or quetiapine). The outcome was cumulative incidence of hypothyroidism per drug, in the presence of the competing risk of ending monotherapy, adjusted for age, sex, physician visits, and thyroid tests.
Adjusting for covariates, the four-year cumulative risk of hypothyroidism for lithium (8.8%) was 1.39-fold that of the lowest risk therapy, oxcarbazepine (6.3%). Lithium was non-statistically significantly different from quetiapine. While lithium conferred a higher risk when compared to all other treatments combined as a group, hypothyroidism risk error bars overlapped for all drugs. Treatment (p = 3.86e-3), age (p = 6.91e-10), sex (p = 3.93e-7), and thyroid testing (p = 2.79e-87) affected risk. Patients taking lithium were tested for hypothyroidism 2.26-3.05 times more frequently than those on other treatments.
Thyroid abnormalities occur frequently in patients with BD regardless of treatment. Therefore, patients should be regularly tested for clinical or subclinical thyroid abnormalities on all therapies and treated as indicated to prevent adverse effects of hormone imbalances on mood.
几十年来，双相情感障碍（BD）患者的甲状腺异常一直与锂盐治疗有关，但对其他药物的研究较少。我们的目的是比较锂盐与常用于BD的抗惊厥药和第二代抗精神病药导致甲状腺功能减退的风险。
采用竞争风险生存分析方法，对24574例BD患者的行政索赔数据进行分析。纳入标准为：（i）既往无甲状腺功能减退诊断且未接受BD药物治疗1年，（ii）随后在使用碳酸锂、心境稳定剂抗惊厥药（拉莫三嗪、丙戊酸盐、奥卡西平或卡马西平）或抗精神病药（阿立哌唑、奥氮平、利培酮或喹硫平）进行BD单一疗法期间至少进行一次甲状腺检查。结果指标是在存在结束单一疗法的竞争风险的情况下，每种药物导致甲状腺功能减退的累积发生率，并根据年龄、性别、医生就诊次数和甲状腺检查进行调整。
校正协变量后，锂盐导致甲状腺功能减退症的4年累积风险（8.8%）是风险最低的疗法奥卡西平（6.3%）的1.39倍。锂盐与喹硫平的差异无统计学意义。虽然与所有其他治疗方法合并作为一组相比，锂盐的风险更高，但所有药物的甲状腺功能减退风险误差线重叠。治疗（p = 3.86e-3）、年龄（p = 6.91e-10）、性别（p = 3.93e-7）和甲状腺检查（p = 2.79e-87）会影响风险。服用锂盐患者进行甲状腺功能减退检查的频率比接受其他治疗的患者高2.26至3.05倍。
无论接受何种治疗，BD患者中甲状腺异常都很常见。因此，应对所有接受治疗的患者定期进行临床或亚临床甲状腺异常检查，并根据指征进行治疗，以预防激素失衡对情绪产生的不良影响。
