A patient taking lithium for bipolar develops weakness, lethargy and cold intolerance.
What investigation should be done at this time?
Correct Answer C:
Chronic lithium use may precipitate thyroid disorders, particularly when there is a family history of hypothyroidism. Therefore, TSH levels should be monitored when lithium is started and then monitor thyroid function every 6 months (+creatinine every 6 months, urinalysis annually).
Which of the following investigations do not need to be performed before starting treatment with lithium carbonate?
Correct Answer D: Two thirds of patients with uncomplicated bipolar disorder respond to lithium.
Lithium may precipitate hypothyroidism, particularly when there is a family history of hypothyroidism. Therefore, TSH levels should be monitored when lithium is started and at least annually if there is a family history or if symptoms suggest thyroid dysfunction or at least biannually for all other patients.
Patients with a history of parenchymal renal disease may be at risk of structural damage to the distal tubule. Renal function should be assessed at baseline, and serum creatinine levels should be monitored over time.
Potential complications of long-term therapy with lithium include which one of the following?
Late-onset polyuria in patients on chronic lithium therapy may indicate the development of acquired renal tubular unresponsiveness to antidiuretic hormone (nephrogenic diabetes insipidus) (choice C) and is usually reversible with discontinuation of the drug.
→ Tardive dyskinesia (choice A) is mainly associated with the use of neuroleptic agents and has not been reported in association with lithium therapy; in fact, lithium has been used experimentally in the management of tardive dyskinesia.
→ Chronic use of lithium induces a mild, benign increase in the number of circulating polymorphonuclear leukocytes, which has led to its experimental use in the treatment of neutropenia. (choice B)
→ Hyperprolactinemia (choice D) has not been reported with lithium therapy, and the cardiovascular effects of lithium include hypotension, not hypertension.
A patient with bipolar disorder is being treated with lithium.
Of the following, which one is the most likely endocrine side effect of this therapy?
Lithium is used as a mood stabilizer in bipolar disease and can be used as monotherapy, especially when the depression is mild. A well-recognized side effect lithium is hypothyroidism (choice C). It is recommended that TSH be monitored in patients treated with lithium.
→ Hyperparathyroidism (choice A), but not hypoparathyroidism, has been reported, but it is not common as hypothyroidism.
→ Hypoaldosteronism (choice B) is not a side effect of lithium therapy.
→ Nephrogenic diabetes insipidus (choice D) has been reported, however it's a renal side effect (not endocrine) of lithium.
→ Hyperandrogenism (choice E) has been reported with drugs such as reserpine, but it is not known to occur with the use of lithium.
A 62-year-old male recently moved and presents to your office for an initial examination. He has bipolar disorder that has been treated with lithium for many years.
Which one of the following should be monitored at regular intervals in patients taking lithium?
Correct Answer D:
Lithium is a mood-stabilizing agent that is used to treat acute manic episodes of bipolar disorder. Long-term complications include the potential for renal impairment and hypothyroidism. It is recommended that renal function be tested every 2-3 months for 6 months and every 6-12 months thereafter. Thyroid function should be evaluated once or twice during the first 6 months of treatment and every 6-12 months thereafter.
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