High rate of autoimmune thyroiditis in bipolar disorder: lack of association with lithium exposure.
BACKGROUND
We assessed the prevalence of thyroperoxidase antibodies (TPO-Abs) and thyroid failure in outpatients with bipolar disorder compared with two control groups.


METHODS
The TPO-Abs of outpatients with DSM-IV bipolar disorder (n = 226), a population control group (n = 252), and psychiatric inpatients of any diagnosis (n = 3190) were measured. Thyroid failure was defined as a raised thyroid stimulating hormone level, previously diagnosed hypothyroidism, or both. Subjects were compared with attention to age, gender, and exposure to lithium.


RESULTS
The TPO-Abs were more prevalent in bipolar patients (28%) than population and psychiatric controls (3-18%). The presence of TPO-Abs in bipolar patients was associated with thyroid failure, but not with age, gender, mood state, rapid cycling, or lithium exposure. Thyroid failure was present in 17% of bipolar patients and more prevalent in women. It was associated with lithium exposure, especially in the presence of TPO-Abs, but not with current rapid cycling, although an association may have been masked by thyroid hormone replacement.


CONCLUSIONS
Thyroid autoimmunity was highly prevalent in this sample of outpatients with bipolar disorder and not associated with lithium treatment. These variables appear to be independent risk factors for the development of hypothyroidism, especially in women with bipolar disorder.
Kupka
Ralph W
RW
Altrecht Centre for Mental Health Care and University Medical Centre Utrecht, Vrouwjuttenhof 18, 3512 PZ Utrecht, The Netherlands.
Nolen
Willem A
WA
Post
Robert M
RM
McElroy
Susan L
SL
Altshuler
Lori L
LL
Denicoff
Kirk D
KD
Frye
Mark A
MA
Keck
Paul E
PE
Leverich
Gabriele S
GS
Rush
A John
AJ
Suppes
Trisha
T
Pollio
Chad
C
Drexhage
Hemmo A
HA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000906:Antibodies / Q000097:blood*; D001714:Bipolar Disorder / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D013967:Thyroiditis, Autoimmune / Q000097:blood* / Q000150:complications; D013972:Thyrotropin / Q000097:blood
D000906:Antibodies; D013972:Thyrotropin; D008094:Lithium