Korean J Biol Psychiatry.  2013 Nov;20(4):151-158.

Subclinical Hypothyroidism in Patients with Bipolar Disorders Managed by Lithium or Valproic Acid

• Choi HM
• Chang JS
• Kim J
• Kim JH
• Choi JE
• Ha TH
• Ha K

Abstract

OBJECTIVES
To investigate the pattern of subclinical hypothyroidism (SCH) in patients with bipolar disorders managed by lithium or valproic acid.
METHODS
The study participants were 106 patients with DSM-IV bipolar disorders receiving planned maintenance treatment at the Mood Disorders Clinic of Seoul National University Bundang Hospital (aged between 17 and 64, mean duration of follow-up = 875.65 days). Using the bipolar disorder registry, thyroid function data were analyzed to assess the frequency of and the risk factors for SCH in patients managed by lithium (n = 64) or valproic acid (n = 42) for more than 5 months.
RESULTS
Overall frequencies of SCH were 20.3% (13/64) in the lithium group, 14.3% (6/42) in the valproic acid group, and between the two groups there is no difference (p = 0.43). No differences were observed in the potential risk factors for SCH between the two groups including age, sex, subtype of bipolar disorder, baseline TSH, and concomitant antipsychotic use. In cases with SCH, thyroid-stimulating hormone (TSH) showed a tendency to increase at 3 month after the initiation of lithium or valproic acid. A gradual increase in the number of patients showing SCH was found within the first 3 years of medication.
CONCLUSIONS
With regular monitoring and careful assessment, there was no difference in the risk of SCH between lithium and valproic acid maintenance. The risk of mood stabilizer-associated SCH may gradually increase within 3 years following the commencement of medication, thereby mandating close monitoring for the first 3 years of treatment. Further studies with large sample size would be needed to confirm these findings.

Keyword

Subclinical hypothyroidism; Bipolar disorder; Lithium; Valproic acid; Mood stabilizer

MeSH Terms

Bipolar Disorder*
Diagnostic and Statistical Manual of Mental Disorders
Follow-Up Studies
Humans
Hypothyroidism*
Lithium*
Mood Disorders
Risk Factors
Sample Size
Seoul
Thyroid Gland
Thyrotropin
Valproic Acid*
Lithium
Thyrotropin
Valproic Acid