Lithium treatment damages more than just the thyroid ( #hyperparathyroidism )

Everyday I wake up thinking I will add to this blog. Almost every day I feel too anxious, weak, confused and a lot of other unpleasant stuff such that I write nothing. Day after day disappears and… well, my life is disappearing, while more and more people are being labelled as bipolar.

I am not a great advert for what happens when in recovery, but at least I am still here, which I am sure I would not be, had I taken all the drugs prescribed.

People who are new to bipolar are still being given lithium as a treatment without the potential consequences being explained.

It is a subject I have thought about for ages. I have had lots of blood tests… I hope one day to have more energy, get to the bottom of this and explain more about how much lithium treatment has affected me. Today, I have just enough energy to post the following which is from:

http://dbt.consultantlive.com/display/article/1145628/1544855?pageNumber=2

Note: Dr Pomeranz is not associated with this site… we just feel strongly that what he says needs to be seen, especially by doctors who come into contact with those being treated with lithium.

Hyperparathyroidism Resulting From Lithium Treatment Remains Underrecognized

By Jay M. Pomerantz, MD | March 26, 2010

Dr Pomerantz practices psychiatry in Longmeadow, Mass, and is assistant clinical professor of psychiatry at Harvard Medical School in Boston.

Until recently, I never paid much attention to the possibility that abnormalities of the parathyroid glands could be relevant to patients in my practice. But I decided to learn more about this issue when one of my patients with bipolar disorder who had been treated with lithium(Drug information on lithium) told me that she had been given a diagnosis of a parathyroid adenoma after her primary care physician noted hypercalcemia on routine testing. Since undergoing successful surgery to remove the adenoma, she is feeling much sharper mentally and more energetic.

Lithium continues to be the gold standard for the treatment of bipolar disorder. It is also helpful for related diagnoses, such as schizoaffective disorder and cyclic major depression. In addition to watching out for the well-known complications of lithium treatment—hypothyroidism and decreased renal function—health care providers should be aware of hyperparathyroidism.

Development of Hyperparathyroidism 
The parathyroid glands are 4 small structures located on the posterior surface of the thyroid gland, which monitor calcium levels in the blood and release parathyroid hormone (PTH).

PTH is a peptide that acts to increase the concentration of calcium in the blood by enhancing the release of calcium from bones. In addition, PTH acts on the kidneys to increase active reabsorption of calcium from distal tubules as well as to increase the excretion of phosphate, also leading to more free calcium in circulation. Finally, PTH raises calcium levels by increasing the production of activated vitamin D, which enhances absorption of calcium by the intestine.

Primary hyperparathyroidism usually results from an adenoma in a single gland, although other causes may be double adenoma or hyperplasia in multiple glands. Previous exposure to radiation in the facial or neck area and certain medications, including thiazide diuretics, may cause primary hyperparathyroidism. In some families, the disease may be inherited. Parathyroid cancer is an extremely rare cause of primary hyperparathyroidism.

Secondary hyperparathyroidism results from any medical condition that causes low calcium levels. This is most often due to kidney failure and the consequent rise in phosphate levels. Vitamin D deficiency is another possible cause.

The lithium connection. It turns out that lithium, a mainstay in the treatment of bipolar disorder, is associated with an increased incidence of hyperparathyroidism. Approximately 15% to 20% of patients receiving long-term lithium treatment show elevated calcium levels, although only a few of these patients also have significant elevations of PTH levels and clinical symptoms of hyperparathyroidism. Interestingly, lithium-associated clinical hyperparathyroidism is almost always caused by a single parathyroid adenoma rather than 4-gland hyperplasia.1

The first case of lithium-associated hyperparathyroidism (LAH) was reported in 1973,2 and many additional reports followed. It appears that longer duration of treatment is associated with an increased incidence of LAH.3Curiously, about 75% of patients receiving lithium in whom LAH develops are women, which is consistent with the overall higher prevalence of hyperparathyroidism in women and unlike the gender-neutral ratio typical of bipolar disorder and lithium use.4

Rather than considering the cessation of lithium treatment when LAH is discovered, which may or may not reverse the calcium and other abnormalities, the usual procedure is to surgically intervene and remove the offending parathyroid glands.

Effects of Hyperparathyroidism
When a parathyroid gland enlarges and produces too much PTH, the blood calcium level becomes high, bones may lose calcium, and kidneys may excrete too much calcium. These changes may give rise to symptoms and signs such as polyuria, thirst, fractures, and kidney stones.

Neuropsychiatric symptoms associated with primary hyperparathyroidism include anxiety as well as cognitive and psychotic presentations. However, the most common presentation is depression with associated apathy.5 In a prospective study of 34 patients with hyperparathyroidism, Velasco and colleagues6 found that approximately one-third of participants had no psychiatric symptoms, one-third had affective symptoms (with or without paranoia), and one-third had cognitive impairment. Affective symptoms were most common in patients with modest elevations in electrolyte levels, while cognitive deficits were more often related to higher calcium concentrations.

Hypercalcemia. The severity of psychiatric symptoms in patients with hyperparathyroidism often correlates with the increase in serum calcium levels. Calcium performs a crucial role in nerve conduction. Consequently, it is no surprise to find out that some common symptoms of parathyroid hyperactivity and high calcium levels are related to the nervous system.

Other symptoms have to do with the muscular system, which uses changes in intracellular calcium concentration to initiate and transmit the command to contract muscle fibers. Improper regulation of calcium levels may result in muscle cramps and weakness. The heart is a muscle, and therefore its conduction system is also vulnerable, with possible shortening of the QT interval, rhythm disturbances, and even cardiac death.

The skeletal system not only functions as the reservoir of calcium for the body, but calcium phosphate(Drug information on calcium phosphate) is an essential ingredient of bone tissue. Consequently, a hyperactive parathyroid system contributes to osteoporosis and vulnerability to bone fractures.

When hypercalcemia is present, it is important not only to screen for hyperparathyroidism but also to rule out other possible underlying conditions, such as malignancy and drug-induced elevations in calcium levels.

Case Note
Already, early in the process of screening for elevated calcium levels in my many patients who are receivinglithium(Drug information on lithium), I have identified a patient with hypercalcemia and a markedly elevated PTH level, which may indicate hyperparathyroidism. She is a 50-year-old woman with schizoaffective disorder who has been receiving long-standing lithium therapy and is undergoing further evaluation by an endocrinologist. All of us are hopeful that her recent cognitive decline and mental apathy will prove to be reversible.

– – – –

About Roger A Smith
Helping you to think about bipolar disorder in different ways so that we can eliminate the disorder and eventually eliminate the need for this diagnosis.

5 Responses to Lithium treatment damages more than just the thyroid ( #hyperparathyroidism )

  1. Jeff says:

    I too am recovering from the effects of years on medication. I don’t have the drive I used to have… I don’t have the energy/motivation… but I am hopeful for the future. On a positive note, I have seen signs of improvement. Since stopping medication, I have had more lucid thoughts… not of the bipolar/out of control realm. But I am feeling more ‘normal.’

    I am the product of medication induced mania. After the mania, I experienced a serious depression and was thus diagnosed ‘bipolar.’ After 2 years of reading and researching this condition, I realize I was misdiagnosed… The DSM IV text revision states that medication induced mania is not to be considered mania. No longer are psychiatrists supposed to label such a patient as bipolar. I fought the diagnosis for 2 years… and stopped meds more than 7 months ago. I am now drug free and recovering.

    There are many people allowing themselves to be labeled bipolar. If someone is depressed, it’s very tempting to simply take a pill to alleviate the awful feeling of depression. This validates the “professionals” diagnosis… but we need to stop this trend. Education is key.

  2. John says:

    Five years of lithium therapy destroyed my life and my ability to give my son a good life. The psychiatrists who prescribe this stuff and see the damage it is doing to you and do not let you know and do not take you off of it are criminals. Killers, literally. Destroyers of lives. Hypercalcemia, multiple parathyroid adenomas, broken teeth, cardiac issues, suicidal ideation, constant anxiety, death of neurons, despair, diabetes insipidus, constant tinnitus, apathy, crying, living in hell. A shortened lifespan spent in a living nightmare. First the death doctors make you “bipolar” with antidepressants, then they give you lithium and finish you off. It’s a horrible world. Our children’s brains and bodies are destroyed with vaccines, fluoride, and we are all given these pharmacological death drugs which kill us and to private our children of sane and healthy parents. We end up as a little more than chemically lobotomized empty shells of our former selves. In the meantime, the powers that be fight against medical marijuana which has no power to maim or kill but only do good if used intelligently, for example. Our medical insurance does not cover natural paths who do not believe in using these deadly pharmacological drugs but in treating the body naturally and safely.

    It’s an insane world where nothing makes sense. I only hope the world to come after this is over is better.

    • Hi John, Thank you for sharing your views. Mostly, mainly, perhaps almost entirely I agree with what you are saying. If only the first psychiatrist I saw had asked how much coffee I’d been drinking instead of assuming my lack of sleep had to be labelled and heavily medicated. Yes, an insane world. Not least because the doctors/psychiatrists continue to be taught to label and prescribe rather than having the time to listen and discuss likely causes that can be tackled without psychiatric drugs.

  3. Penny Shaver says:

    I’m part of this problem. I’m caught up in the game between two Doctors. My psychiatrist prescribes lithium. My metabolic Doctor watches my thyroid damaged by radiation. Anyway I have been overall not feeling good. Legs hurt. Feels like I’m dragging logs. Blurred vision. Out of breath. So far they closed two leg veins said the valves were not working. That did not resolve the problem.

    So, metabolic doctor checked the calcium levels and PTH levels. All high. He called the Physchiatrist and now I’m weaning off the lithium. He put me on another whacko drug. The metabolic Doctor says I need surgery. The Physchiatrist says No I don’t. Then they had lunch they are friends. Go figure. Now the metabolic Doctor says let wait and see. WTH! My teeth are breaking and I’m concerned about my carotid artery. I only have one carotid and it’s stented. Calcium levels causing problems??? And heard it causes high blood pressure. Taking 3 meds. What good does that do now? I can go on and on. Want to talk to a lawyer.

    • Hi Penny,
      I’m not a lawyer or doctor. It seems I live 3,000 or more miles away from you in a very different culture. I have been through something a tiny bit like what you are experiencing and found a way through to a somewhat better life, so it may be worth having a conversation by email. I can only share what seems to have worked for me and others who were on a lot of medication and are now feel they are doing better on less or more appropriate medication.

      Personally, I’m free of all prescription drugs and back to my busy-self. Right now, I am not claiming that is ‘cured’ as it is a massive challenge to keep up with half of what I want to be doing.

      It seems horrible that the professionals all seem to be pulling (or pushing?) you in different directions and perhaps no good direction at all.

      Your email address has been registered when you left your comment. I hope to email you soon.

      Best wishes Roger (in UK)

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