{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:09:17Z","timestamp":1792112957223,"version":"4.4.0"},"reference-count":51,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Low doses of lithium, as might be used for mood or dementia prevention, do not carry the same renal, toxicity, and tolerability problems of doses used for prophylaxis or treatment of mania. However, thyroid effects of low doses have not been investigated. Our goal in this study was to assess the changes in thyroid\u2010stimulating hormone (TSH) associated with a broad range of lithium levels, including those well below the therapeutic range for bipolar disorders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study was conducted in a small healthcare system with 19 associated primary care clinics served by a Collaborative Care program of psychiatric consultation. In this retrospective review of electronic records, we searched for patients who had received a lithium prescription and both pre\u2010 and post\u2010lithium thyroid\u2010stimulating hormone (TSH) levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with low lithium levels (&lt;0.5\u2009mEq\/L, <jats:italic>N<\/jats:italic>\u2009=\u2009197) had a mean thyroid\u2010stimulating hormone (TSH) increase of 0.52\u2009mIU\/L. Patients with maintenance lithium levels (0.5\u20130.8\u2009mEq\/L; <jats:italic>N<\/jats:italic>\u2009=\u2009123) had a mean TSH increase of 1.01\u2009mIU\/L; and patients with antimanic lithium levels (&gt;0.8\u2009mEq\/L; <jats:italic>N<\/jats:italic>\u2009=\u200979) had a mean TSH increase of 2.16\u2009mIU\/L. The probability of TSH exceeding the upper limit of normal in our laboratory (&gt;4.2\u2009mIU\/L) was positively associated with pre\u2010lithium TSH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results suggest that the risk of lithium\u2010induced hypothyroidism is dose\u2010related, and relatively small with very low doses, but thyroid monitoring, including a pre\u2010lithium TSH, is still warranted.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.13377","type":"journal-article","created":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T23:04:48Z","timestamp":1694646288000},"page":"129-135","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Low and very low lithium levels: Thyroid effects are small but still require monitoring"],"prefix":"10.1111","volume":"26","author":[{"given":"James","family":"Phelps","sequence":"first","affiliation":[{"name":"Samaritan Mental Health, Samaritan Health Services  Corvallis Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia Pipitone","family":"Coskey","sequence":"additional","affiliation":[{"name":"Graduate Medical Education, Samaritan Health Services  Corvallis Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1503\/jpn.160132"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40261-017-0533-6"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2020.19050599"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.13299"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/bdi.13306"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/psychiatry.IndianJPsychiatry_293_19"},{"key":"e_1_2_10_8_1","unstructured":"HayesJ.Lithium should be more widely used for bipolar disorder. 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