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February 13, 2025 – A recent study published in JAMA Network Open has found that lithium treatment is associated with an increased risk of thyroid dysfunction and chronic kidney disease (CKD) in individuals diagnosed with bipolar disorder (BD). The study, conducted by Joe Kwun Nam Chan, Ph.D., and colleagues from the University of Hong Kong, provides new insights into the potential long-term effects of lithium use.
The research examined data from patients aged 15 years or older in Hong Kong who had been diagnosed with incident bipolar disorder and treated with lithium, other mood stabilizers, and antipsychotic medications. In total, 4,752, 4,500, and 7,029 individuals were analyzed for hypothyroidism, hyperthyroidism, and CKD, respectively.
Key Findings:
- Lithium use was linked to a twofold increased risk of hypothyroidism and a 1.35 times higher risk of CKD3+ (moderate to severe CKD), compared to nonlithium treatments.
- No significant association was found between lithium use and advanced CKD stages (CKD4+ or end-stage kidney disease).
- Higher lithium serum levels correlated with increased risks of hypothyroidism, hyperthyroidism, and CKD3+ (adjusted hazard ratios: 2.08, 1.81, and 2.11, respectively).
- A greater number of lithium toxicity episodes was associated with an elevated risk of CKD3+.
- Alternative treatments such as valproate, olanzapine, quetiapine, and risperidone showed a lower likelihood of thyroid dysfunction and CKD3+ compared to lithium.
- Specific serum lithium thresholds (>0.5028, >0.5034, and >0.5865 mEq/L) were identified as indicators for increased risk of hypothyroidism, hyperthyroidism, and CKD3+.
Clinical Implications:
The study highlights the importance of regular monitoring of thyroid and kidney function in bipolar disorder patients receiving lithium therapy. The authors emphasize that their findings provide empirical evidence to guide clinicians in balancing the efficacy and safety of lithium treatment.
“By identifying thresholds of lithium serum levels linked to thyroid and kidney abnormalities, our research aims to refine clinical guidelines and ensure safer long-term use of lithium for bipolar disorder management,” the study authors stated.
Several authors of the study disclosed financial ties to the pharmaceutical and medical technology industries.
For more details, refer to the original study: Joe Kwun Nam Chan et al, Lithium for Bipolar Disorder and Risk of Thyroid Dysfunction and Chronic Kidney Disease, JAMA Network Open (2025). DOI: 10.1001/jamanetworkopen.2024.58608.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Patients should consult their healthcare providers before making any changes to their treatment plans.
