Arnold G. Blumberg

The effect of lithium on thyroid functioning: A controlled study ☆

THE EFFECTS of lithium on thyroid function have recently been reviewed by SHOPSIN.~ Anecdotal reports of hypothyroidism and goiter are described. Controlled human studies have been done by SEDVALL et aL2 and COOPER and SIMPSON.~ SEDVALL et al.2 gave lithium to 14 manic-depressives and used 11 patients receiving phenothiazines, with other diagnoses as controls. The lithium treatment was begun, “about one week after admission to the hospital. . . . Tests of thyroid function were performed during the first week after admission to hospital and 10 to 14 days later. At the latter time lithium treatment in the manic-depressive patients had been maintained for 7 to 20 days.” A personal communication from the senior author indicates that the initial thyroid function tests were all done prior to initiation of lithium, and the second series of tests were done 7 -20 days after lithium was begun, and not 10-14 days as published. Compared to the first test, there was a significant decrease in protein bound iodine (PBI) and a significant increase in the percentage of orally administered radioactive iodine (24 hr RAIl”l) in the thyroid after 24 hr, in the lithium treated manic-depressed patients. There were no changes in the control patients. It is difficult to evaluate the significance of these results because the control group had different diagnoses and received an active drug that may affect thyroid function tests.4 COOPER and SIMPSON~ compared PBI and free thyroxine in 25 manic-depressives two weeks after initiating lithium treatment to 139 other psychiatric admissions (excluding organic psychoses) who had blood drawn while drug free. The PBI and free thyroxine were significantly reduced in the lithium group. They also compared RAIU (24 hr) before, and 12-16 weeks after lithium treatment in 12 manic-depressives and found a significant increase following lithium treatment. BURROW et aL5 studied 9 patients before and after 3-4 weeks of lithium therapy. Some patients received concomitant psychotropic drugs and perhaps diphenylhydantoin or oral contraceptives. The patients were hospitalized and diagnosed as having “mood disorders” although one patient may have been hospitalized for a seizure disorder. They found that *We wish to acknowledge the help we received in the statistical computations from Mrs. Dolores Millan

Chlorpromazine-procyclidine and imipramine: effects on thyroid function in psychiatric patients.

A series of thyroid function tests were performed on 84 randomly assigned psychiatric patients receiving chlorpromazine‐procyclidine, imipramine, or placebo, before and after treatment. The rate of uptake of 1s1I and the 24 hour level of uptake of 1s1I by the thyroid gland was increased by chlorpromazine‐procyclidine but not by imipramine. Renal clearance of 1s1I was diminished by treatment with chlorpromazine‐procyclidine but not by imipramine. PBI, T3 resin uptake, and ankle jerk were not significantly altered.

Methoxy-catecholamine excretion and the mecholyl test

written comprehensive reviews of various studies and problems in the measurement and interpretation of the mecholyl test. BLUMBERG~ reported on the reproducibility of the test and defined the limits of variance of a single measurement derived from the mecholyl response, i.e. the mecholyl area. This mecholyl area, being an algebraic sum of both hypotensive and hypertensive portions of the response, was found to be more reproducible than any scoring based on the shape of the actual curve. The response of the systolic blood pressure to an injection of mecholyl is the resultant of an interconnected series of events, beginning with the reaction of the target organ to mecholyl with dilation of blood vessels. The degree of alteration of blood pressure level may be determined by the elastic dynamics of the vessels, the sensitivity of the circulatory baroceptors and the state of responsivity of the central autonomic regulatory mechanisms and of the effector neurons to central stimulation. The efferent compensatory response may involve the release of sympathetic amines, such as E and NE, into the circulation. The modal level of continuous activity of the sympathetic nervous system may be defined as sympathetic tone. Sympathetic reactivity may be defined as the compensatory response of the sympathetic nervous system to alterations in resting states, and may entail changes in outflow from the diencephalon and secondarily increased release of pressor amines. However, mecholyl response need not be governed by autonomic nervous system factors alone. The elasticity of blood vessels diminishes with age and the compensatory vasoconstrictor response of the blood vessels to central stimulation may be weaker and

RELATIONSHIPS OF THE MECHOLYL TEST, PREMORBID ASOCIAL FUNCTIONING, AND LONG TERM OUTCOME IN SCHIZOPHRENIA

This study addressed itself to the controversy whether magnitude of mecholyl response is related to premorbid characteristics and/or long term outcome in nonchronic schizophrenics. It was found that in a group of 46 schizophrenics the ratings of premorbid asocial functioning were correlated with outcome. However, both of these patient characteristics were independent of the magnitude of a mecholyl-induced drop in systolic blood pressure. Similar results were obtained when the schizophrenic sample was combined with 33 nonschizophrenic patients, thus suggesting that diagnostic variation among studies cannot account for contradictory results regarding the relationship between mecholyl response, process-reactive schizophrenia, and long term outcome.

Age, base blood pressure, diagnosis, and mecholyl test response.

&NA; Systolic blood pressure responses to the injection of methacholine (Mecholyl responses) of 338 psychiatric patients were correlated with age, psychiatric diagnosis, and base blood pressure. The Mecholyl area was significantly correlated with age, diagnosis, and base blood pressure. Age proved to be more effective in discriminating between diagnoses than was base blood pressure, which was more effective than Mecholyl area (planimetrically determined from a graph). Standardization techniques for truncation of range indicated that the correlation of Mecholyl area with age within diagnoses held for psychotics, but was not observed in character disorders. When age was partialled out, the correlations between diagnosis and Mecholyl area were no longer significant.