Maarbjerg K, Vestergaard P, Schou M
Acta Psychiatr Scand. 1987 Feb;75(2):217-21. doi: 10.1111/j.1600-0447.1987.tb02778.x.
We determined serum T4 and serum TSH serially in a cohort of patients given lithium treatment for up to 6 years; the total lithium exposure time was 409 years and the average serum lithium concentration 0.69 mmol/l. T4 showed a small and not significant fall at 6 months and returned to the pre-lithium level at 12 months. Hereafter, T4 rose gradually and after 6 years of lithium treatment T4 was 53% higher than the pre-lithium value. TSH was significantly increased at 6 and 12 months and then returned to the pre-lithium level. Eight patients required thyroxine treatment for lithium-induced hypothyroidism, i.e. 2 per 100 years of lithium exposure time. Single deviant values of T4 and TSH could be seen, followed by normal values. We suggest that TSH is determined at intervals during lithium treatment. It may be prudent to subject lithium-treated patients with abnormal thyroid values to re-examination and to abstain from starting thyroxine treatment on the basis of a single deviant value.
我们对一组接受锂盐治疗长达6年的患者进行了血清T4和血清促甲状腺激素（TSH）的连续检测；锂盐的总暴露时间为409年，平均血清锂浓度为0.69 mmol/L。T4在6个月时出现小幅下降但不显著，并在12个月时恢复到锂盐治疗前水平。此后，T4逐渐上升，锂盐治疗6年后，T4比治疗前值高出53%。TSH在6个月和12个月时显著升高，然后恢复到锂盐治疗前水平。8名患者因锂盐所致甲状腺功能减退需要甲状腺素治疗，即每100年锂盐暴露时间有2例。可以看到T4和TSH的个别异常值，随后为正常数值。我们建议在锂盐治疗期间定期检测TSH。对于甲状腺值异常的锂盐治疗患者，基于单个异常值进行复查并避免开始甲状腺素治疗可能是谨慎的做法。
