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

Choi, Hyeon Man (Department of Psychiatry, Seoul National University Hospital)
Chang, Jae Seung (Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine)
Kim, Jayoun (Department of Psychiatry, Seoul National University Bundang Hospital)
Kim, Jeong Hyun (Mental Health & Behavioral Medicine Services for Clinical, Seoul National University Bundang Hospital)
Choi, Jung Eun (Department of Psychiatry, Seoul Eunpyeong Hospital)
Ha, Tae Hyon (Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine)
Ha, Kyooseob (Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine)
Publication Information
Korean Journal of Biological Psychiatry / v.20, no.4, 2013 , pp. 151-158 More about this Journal
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.
Keywords
Subclinical hypothyroidism; Bipolar disorder; Lithium; Valproic acid; Mood stabilizer;
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