Lithium Linked to Risk for Thyroid Dysfunction, CKD in Bipolar Disorder

WEDNESDAY, Feb. 12, 2025 (HealthDay News) — Lithium is associated with an increased risk for thyroid dysfunction and chronic kidney disease (CKD) in patients with incident bipolar disorder (BD), according to a study published online Feb. 11 in JAMA Network Open.

Joe Kwun Nam Chan, Ph.D., from the University of Hong Kong, and colleagues examined the risk for thyroid and kidney dysfunction in patients aged 15 years or older with incident BD treated with lithium and other mood stabilizers and antipsychotics in an Asian population in Hong Kong.

Overall, 4,752, 4,500, and 7,029 individuals had analyzable data for hypothyroidism, hyperthyroidism, and CKD, respectively. The researchers found that compared with nonlithium treatments, lithium was associated with an increased risk for hypothyroidism and CKD3+ (adjusted hazard ratios, 2.00 and 1.35, respectively), but not with CKD4+ or end-stage kidney disease. Elevated rates of hypothyroidism, hyperthyroidism, and CKD3+ were seen in association with higher lithium serum levels (adjusted hazard ratios, 2.08, 1.81, and 2.11, respectively). There was an association seen for a greater number of lithium toxicity episodes with increased CKD3+ risk. Compared with lithium, valproate, olanzapine, quetiapine, and risperidone generally exhibited a lower likelihood of thyroid dysfunction and CKD3+, with no difference in advanced CKD. Mean lithium serum levels >0.5028, >0.5034, and >0.5865 mEq/L represented thresholds associated with hypothyroidism, hyperthyroidism, and CKD3+, respectively.

“Our findings further identified thresholds of lithium serum levels associated with thyroid and kidney abnormalities, thereby providing empirical evidence to inform clinical guidelines on recommending lithium treatment that balances the efficacy and safety,” the authors write.

Several authors disclosed ties to the pharmaceutical and medical technology industries.

Abstract/Full Text