Bipolar and Related Disorders: The Daily PANCE Blueprint
A 42-year-old man with bipolar disorder presents to your clinic for a follow-up. He has been stable on lithium therapy for the past year. As part of his routine monitoring while on lithium, which of the following should be regularly monitored to ensure safety and efficacy of the treatment?
A. EKG
B. Liver enzymes
C. Potassium
D. Thyroid function
E. White blood cell count
Answer and topic summary
The answer is D. Thyroid function
Lithium is considered a first-line medication for bipolar disorder and has been more widely studied than any other maintenance treatment for this condition, consistently supported across multiple randomized trials. Lithium therapy can affect thyroid function, potentially causing hypothyroidism, chronic autoimmune thyroiditis, and goiter. Therefore, it is crucial to monitor thyroid function regularly. The recommended monitoring includes pretreatment thyroid function tests (TFTs), assessment 1-2 times in the first six months, and then every 6-12 months thereafter. This regular monitoring ensures early detection and management of thyroid dysfunction, which is a common adverse effect of lithium.
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