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Long-term results of surgery for lithium-associated hyperparathyroidism
Ryhov Hospital, Jönköping, Sweden.
NÄL Trollhättan, Trollhättan, Sweden.
Ryhov Hospital, Jönköping, Sweden.
Sahlgrenska University Hospital, Göteborg, Sweden.
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2010 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 97, no 11, p. 1680-1685Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Lithium therapy for affective bipolar disease is frequently associated with hyperparathyroidism (HPT), but the results of surgical treatment are virtually unknown. The aim of this retrospective review was to analyse the long-term outcome after surgery for lithium-induced HPT in a large series of patients.

METHODS: Seventy-one patients on chronic lithium therapy who underwent surgery in three university and three district hospitals in Sweden were followed for a median of 6.3 years. Histopathology, complications of surgery and normocalcaemia at 6 months after surgery and last follow-up were analysed.

RESULTS: The primary histopathological diagnoses were adenoma (45 per cent), double adenomas (3 per cent) and hyperplasia (52 per cent). No permanent paresis of the recurrent laryngeal nerve was recorded but 13 per cent of the patients suffered from permanent hypoparathyroidism. At follow-up, the rate of persistent and recurrent HPT was 42 per cent regardless of the histopathological diagnosis.

CONCLUSION: The results of conventional surgery for lithium-associated HPT are poor. The surgical approach should be adjusted for the multiglandular disease that is usually the cause of HPT in patients on chronic lithium therapy.

Place, publisher, year, edition, pages
2010. Vol. 97, no 11, p. 1680-1685
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-65825DOI: 10.1002/bjs.7199ISI: 000282651100015PubMedID: 20665482Scopus ID: 2-s2.0-78049394343OAI: oai:DiVA.org:oru-65825DiVA, id: diva2:1190663
Available from: 2018-03-15 Created: 2018-03-15 Last updated: 2018-03-15Bibliographically approved
In thesis
1. Lithium-associated hyperparathyroidism: Prevalence, Pathophysiology, Management
Open this publication in new window or tab >>Lithium-associated hyperparathyroidism: Prevalence, Pathophysiology, Management
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Lithium has been used in the treatment of bipolar disorder, formerly called manic depression, for nearly seven decades. Lithium-associated hyperparathyroidism (LHPT) is an ill-defined and less well known possible side-effect of chronic lithium therapy and was first described in 1973. The condition has been considered to be rare, though there exists conflicting evidence as to its prevalence, its pathophysiological background, and, if and when identified, what the appropriate medical or surgical treatment should be. The principal aim of this thesis was to understand and more comprehensively characterise this condition through studying a large patient cohort, with regards its prevalence, development, and additionally by providing an evaluation of surgical management up until now.

In Study I a population of 423 lithium-treated out-patients (251 women, 172 men) were recruited from Jönköping and Örebro County. We found that 18% met the criteria for hyperparathyroidism (HPT) and that a further 21% had intermittent episodes of hypercalcaemia. We then examined, in Study II, the effects of lithium only in patients with bipolar disorder and compared them, firstly, to patients with bipolar disorder without lithium and, secondly, to a control population. In total, 563 individuals participated in the study. Hypercalcaemia was found to be strongly associated to lithium therapy (adjusted OR 13.45; 95% CI 3.09, 58.55; p=0.001). Study III is a descriptive study of calcium homeostasis in 297 lithium-treated patients from Jönköping where three main groups could be discerned: 178 were normocalcaemic (60%), 102 hypercalcaemic (34%), and 17 hypocalcaemic (6%). Many patients demonstrate robust fluctuations in serum calcium intermittently. Of those with suspected LHPT, 31% had urinary calcium excretion values be-low 1.2 mmol/24hrs. Study IV analysed surgical results of 78 parathyroidectomies in 71 patients with concurrent lithium therapy. In strong contrast to surgical outcomes in those with primary HPT, the overall cure-rate was lower (58%) and the predominant histological diagnosis was hyperplasia (52%). Two patients had double adenomas.

Factors which should be particularly taken into consideration while monitoring lithium-treated patients are age, gender and lithium-duration.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2018. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 174
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-65002 (URN)978-91-7529-234-2 (ISBN)
Public defence
2018-04-06, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
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Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-03-15Bibliographically approved

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