Bann Sewon, Nguyen Anne, Gill Sabrina, Raudzus Julia, Holmes Daniel T, Wiseman Sam M
Department of Endocrinology & Metabolism, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada.
J Affect Disord. 2023 Oct 15;339:471-477. doi: 10.1016/j.jad.2023.07.037. Epub 2023 Jul 11.
This study aims to estimate the prevalence of and determine physician approaches to the screening and management of lithium-associated thyroid and parathyroid disorders in British Columbia, Canada.
Serum lithium and thyroid/parathyroid laboratory data were collected retrospectively for patients with lithium levels measured at seven BC hospitals between 2012 and 2021. A mail-out survey about screening and management of thyroid/parathyroid disorders in patients on lithium was sent to the ordering physicians of patients with abnormal results. Three months after, a follow-up questionnaire was sent to respondents, and the original survey was re-sent to non-responders.
Of 4917 patients, 1.9 % had PTH (mean 22.33 ± 23.00 pmol/L) and 77.1 % had TSH (mean 3.61 ± 6.69 pmol/L) measured. Of 222 hypercalcemic patients (defined as any serum calcium or ionized calcium above the laboratory reference), 17.6 % had a PTH level measured. From 294 surveys sent to 214 physicians, the overall response rate was 31.6 % (n = 93) with twelve fully completed surveys. All twelve respondents monitored TSH levels every 6-12 months, and eight physicians monitored PTH and/or calcium at variable intervals. Two physicians routinely ordered both thyroid and parathyroid screening laboratory tests. Of the 80 non-respondents, limited patient contact was the most common reason for opting out (n = 27).
Our results suggest biochemical screening for lithium-associated parathyroid disorders is less common than for thyroid disorders. There is insufficient data to determine the true prevalence of lithium-associated thyroid and parathyroid disorders. This highlights the need for updated clinical guidelines for management of lithium-associated thyroid and parathyroid disorders.
本研究旨在估计加拿大不列颠哥伦比亚省锂相关甲状腺和甲状旁腺疾病的患病率，并确定医生对其筛查和管理的方法。
回顾性收集2012年至2021年期间在不列颠哥伦比亚省七家医院测量锂水平的患者的血清锂和甲状腺/甲状旁腺实验室数据。向结果异常患者的开单医生发送了一份关于锂治疗患者甲状腺/甲状旁腺疾病筛查和管理的邮寄调查问卷。三个月后，向受访者发送了一份随访问卷，并将原始调查问卷重新发送给未回复者。
在4917名患者中，1.9%检测了甲状旁腺激素（平均22.33±23.00pmol/L），77.1%检测了促甲状腺激素（平均3.61±6.69pmol/L）。在222名高钙血症患者（定义为任何血清钙或离子钙高于实验室参考值）中，17.6%检测了甲状旁腺激素水平。在向214名医生发送的294份调查问卷中，总体回复率为31.6%（n=93），其中12份调查问卷填写完整。所有12名受访者每6至12个月监测促甲状腺激素水平，8名医生以不同间隔监测甲状旁腺激素和/或钙水平。两名医生常规开具甲状腺和甲状旁腺筛查实验室检查单。在80名未回复者中，与患者接触有限是最常见的退出原因（n=27）。
我们的结果表明，锂相关甲状旁腺疾病的生化筛查不如甲状腺疾病常见。没有足够的数据来确定锂相关甲状腺和甲状旁腺疾病的真实患病率。这凸显了更新锂相关甲状腺和甲状旁腺疾病管理临床指南的必要性。
