Bipolar hastalarda kısa ve uzun süreli lityum tedavisinin tiroid hormonları üzerine etkisi

Amaç: Lityum tedavisinin subklinik veya klinik hipotiroidizme yol açabileceği bilinmektedir. Biz bu çalışmada, lityuma bağlı tiroid hormon değişikliklerinin kısa ve uzun süreli lityum kullanan hastalarda farklı olup olmadığını incelemeyi amaçladık. Yöntem: Onyedi kısa süreli (4 hafta) (7 kadın, 10 erkek; yaş ortalaması ± SS: 29.41 ± 7.33), 22 uzun süreli (ortalama 34 ay) (9 kadın, 13 erkek; yaş ortalaması ±SS: 32.13±7.72) lityum tedavisi almakta olan hasta ve 19 sağlıklı denek (9 kadın, 10 erkek; yaş ortalaması ± SS: 29.68 ± 9.75) çalışmaya alındı. Kısa süreli tedavi grubunda lityum başlamadan önce ve 4. haftanın sonunda olmak üzere iki kez, uzun süreli tedavi grubunda ve kontrol grubunda ise bir kez standart radioimmunoassay (RIA) yöntemiyle serum tiroid hormon değerlerinin (T3, T4, serbest T3, serbest T4 ve TSH) ve pasif hemaglütinasyon yöntemiyle antitiroid antikorların ölçümü yapıldı. Bulgular: Hem kısa süreli, hem de uzun süreli tedavi grubunda kontrollere göre serbest T4 düzeylerinde azalma ve TSH düzeylerinde artma, ayrıca uzun süreli tedavi grubunda serbest T3 konsantrasyonunda artma olduğu bulundu. Hiçbir grupta antitiroid antikorlar saptanmadı. Sonuç: Bu sonuçlar, lityuma bağlı olan tiroid hormon değişikliklerinin uzun süreli tedavide de devam etme eğiliminde olduğunu ve ilacın tiroidi baskılayıcı etkisinin tiroid otoimmünitesini tetikleyici etkisinden çok, onun tiroid bezi üzerine, doğrudan toksik etkisine bağlı olduğunu düşündürmektedir.

Thyroid hormone profile in bipolar patients on short and long term lithium treatment

Objective: it is well known that lithium treatment may cause subclinical and clinical hypothyroidism. in this study, we investigated whether lithium-induced thyroid abnormalities in patients on short-term lithium treatment differ from those in patients on long-term treatment. Method: Seventeen bipolar patients (7 females, 10 males; mean age ± SD: 29.41 ±7.33) on the short-term lithium treatment (4 weeks) and 22 bipolar patients (9 females, 13 males; mean age ± SD: 32.13 ± 7.72) on long-term lithium treatment (average 34 months) and 19 healthy controls (9 females, 10 males; mean age ± SD: 29.68 ± 9.75) were included in the study. Thyroid hormone variables (T3,T4,free T3,free T4 and TSH) were measured by Standard radioimmunoassay (RIA) and antithyroid antibodies were investigated by passive hemagglutination on two occasions in the short-term treatment group (before and 4 weeks aft er the start of lithium treatment) and once in the long-term treatment and control groups. Results: it was found that there was a decrease in free T4 levels along with an increase in TSH levels in both the short-term and long-term groups, and there was an increase in free T3 levels in the long-term group compared with the controls. No antibodies were found in any of the groups. Conclusion: Our data suggest that lithium-induced thyroidal abnormalities tend to continue during long-term lithium treatment, and the antithyroid effect of the drug may result from its direct toxic effect on the thyroid gland rather than its property of inducing thyroid autoimmunity

Kaynakça

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