超声测定锂盐预防治疗的双相障碍个体与健康对照者的甲状腺体积。
Ultrasonically Determined Thyroid Volume in Individuals with Bipolar Disorder on Lithium Prophylaxis Compared with Healthy Controls.
机构信息
Dr. Bhasin, Formerly, Junior Resident, Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India, Present Affiliation: Senior Resident, Institute of Liver and Biliary Sciences, New Delhi, India.
Dr. Kandasamy, Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
出版信息
Psychopharmacol Bull. 2024 Aug 19;54(4):18-34.
INTRODUCTION
Lithium is a gold-standard agent for bipolar disorder (BD) and can affect the size, structure and/or function of thyroid gland with long-term exposure. Thyroid ultrasound can detect structural thyroid abnormalities, but it is under-reported with few prior studies in lithium users. The study aimed to evaluate thyroid volume and echogenicity in lithium users with BD and healthy participants, and explores its association with clinical variables and thyroid functions.
METHOD
This was an observational study with 102 participants in total. Study group consisted of 52 clinically-stable (HAM-D ≤ 13, YMRS <8) follow-up patients with DSM-5 BD on lithium maintenance. Healthy controls (HC) comprised 50 participants with no illness in self and family. Assessments included NIMH Life-chart, IGLSI typical/atypical scale, lithium response scale (LRS) and CGI-BP. Fasting venous sample was taken for thyroid functions, Anti-TPO antibodies and serum lithium. Thyroid ultrasonography was also conducted.
RESULTS
Mean age of cases was 39.42 ± 12.62 years, with 42.3% females, which was comparable to HC. Median duration of illness was 10.5 years (Q1-Q3 = 6-19 years), with median lithium exposure for 4.5 years (Q1-Q3:2.2-7.75), and serum lithium 0.67 mmol/L (SD:0.31). Thyroid volume was significantly higher for cases than HC (10.67 ± 5.46 mL vs 4.30 ± 2.06 mL; p < 0.001). Relative to HC, serum TSH was higher in cases (p = 0.018), while anti-TPO positivity was comparable (14.0% vs 3.85%, p = 0.089). Thyroid nodules were more frequent in male cases (p = 0.013) compared to male controls.Thyroid volume did not show association with serum TSH (p = 0.277) and lithium response (p = 0.36).
CONCLUSION
Findings indicate a uniform enlargement of thyroid gland in lithium users with BD. Thyroid volume did not show association with thyroid functions and lithium response, however prospective studies may give better insight about their trajectories over time.
简介
锂是双相情感障碍（BD）的金标准治疗药物，长期暴露于锂可影响甲状腺的大小、结构和/或功能。甲状腺超声可检测到甲状腺结构异常，但由于先前的研究较少，报道较少。本研究旨在评估锂治疗的 BD 患者和健康参与者的甲状腺体积和回声，探讨其与临床变量和甲状腺功能的关系。
方法
这是一项观察性研究，共纳入 102 名参与者。研究组由 52 名接受锂维持治疗的 DSM-5 BD 临床稳定（HAM-D≤13，YMRS<8）的随访患者组成。健康对照组（HC）包括 50 名自我和家族均无疾病的参与者。评估包括 NIMH 生活图表、IGLSI 典型/非典型量表、锂反应量表（LRS）和 CGI-BP。采集空腹静脉血样检测甲状腺功能、抗 TPO 抗体和血清锂。还进行了甲状腺超声检查。
结果
病例组的平均年龄为 39.42±12.62 岁，女性占 42.3%，与 HC 相似。中位病程为 10.5 年（Q1-Q3=6-19 年），中位锂暴露时间为 4.5 年（Q1-Q3：2.2-7.75），血清锂 0.67mmol/L（SD：0.31）。病例组的甲状腺体积明显大于 HC（10.67±5.46ml 比 4.30±2.06ml；p<0.001）。与 HC 相比，病例组血清 TSH 较高（p=0.018），而抗 TPO 阳性率相似（14.0%比 3.85%，p=0.089）。与男性 HC 相比，男性病例中甲状腺结节更为常见（p=0.013）。甲状腺体积与血清 TSH（p=0.277）和锂反应（p=0.36）无相关性。
结论
研究结果表明，BD 锂治疗患者的甲状腺普遍肿大。甲状腺体积与甲状腺功能和锂反应无相关性，但前瞻性研究可能会更好地了解它们随时间的变化轨迹。
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