Introduction
Historic background
Aims of the study
Materials and methods
Assessment of hypercalcemia
Variables | Bipolar with lithium (n = 313) | Bipolar without lithium (n = 137) | Control population (n = 102) | Total population (n = 552) |
p value* |
---|---|---|---|---|---|
Female, n (%) | 188 (60) | 88 (60) | 62 (61) | 338 (60) | 0.989 |
Age, median years (range) | 57 (19–92) | 35 (18–74) | 34 (21–75) | 48 (18–92) | ≤0.001 |
Calcium mmol/l, median (range) (ref: 2.10–2.50) | 2.43 (2.17–2.86) | 2.29 (2.05–2.53) | 2.26 (2.05–2.56) | 2.38 (2.05–2.86) | ≤0.001 |
PTH ng/l, median (range) (ref: 10–73)€
| 65 (22–305) | n/a§
| n/a | – | – |
Creatinine µmol/l, median (range) (ref: ♀ 45–90, ♂ 60–105) | 77 (46–139) | 67 (39–140) | 69 (45–100) | 73 (39–140) | ≤0.001 |
Hypercalcemia, ≥ 2 episodes of 2.50 mmol/l (% of subsample) | 82 (26.2) | 2 (1.4) | 3 (2.9) | 87 (15.5) | ≤0.001 |
Pathological TSH, n (%) | 115 (36.7) | 27 (19.7) | 5 (4.9) | 147 (26.6) | ≤0.001 |
GAF-symptom scale, median (range)#
| 65 (25–97) | 65 (45–85) | 80 (60–92) | 70 (25–97) | ≤0.001 |
Duration of mood-stabilizing therapy, median years (range)¤
| 14 (2–44) | 12 (1–33) | – | – | 0.115 |
Use of medications | |||||
Levothyroxine, n (%) | 89 (28.4) | 9 (6.6) | 1 (1.0) | 99 (17.9) | ≤0.001 |
Antidepressants, n (%) | 142 (45.4) | 39 (28.5) | 1 (1.0) | 182 (33.0) | ≤0.001 |
Antipsychotics, n (%) | 105 (33.5) | 27 (19.7) | 0 (0.0) | 132 (23.9) | ≤0.001 |
Anxiolytics, n (%) | 49 (15.7) | 22 (16.1) | 0 (0.0) | 71 (12.9) | ≤0.001 |
“Non-psychiatric” medications, n (%) | 207 (66.1) | 47 (34.3) | 41 (40.2) | 295 (53.4) | ≤0.001 |
Statistical analysis
Ethics
Results
Variables | Hypercalcemia (n = 87) | Normocalcemic (n = 465) | Total population (n = 552) |
p value* |
---|---|---|---|---|
Study groups | ||||
Bipolar with lithium, n (%) | 82 (94.3) | 231 (49.7) | 313 (56.7) | ≤0.001 |
Bipolar without lithium, n (%) | 2 (2.3) | 135 (29.0) | 137 (24.8) | |
Control population, n (%) | 3 (3.4) | 99 (21.3) | 102 (18.5) | |
Female, n (%) | 67 (77.0) | 266 (57.2) | 333 (60.3) | ≤0.001 |
Age, median years (range) | 64 (24–90) | 45 (18–92) | 47 (18–92) | ≤0.001 |
Calcium mmol/l, median (range) (ref: 2.10–2.50) | 2.57 (2.50–2.86) | 2.36 (2.05–2.50) | 2.38 (2.05–2.86) | ≤0.001 |
Creatinine µmol/l, median (range) (ref: ♀ 45–90, ♂ 60–105) | 78 (45–130) | 72 (39–140) | 73 (39–140) | 0.161 |
Pathological TSH, n (%) | 42 (48.3) | 105 (22.6) | 147 (26.6) | ≤0.001 |
GAF-symptom scale, median (IQR)#
| 68 (53–75) | 70 (60–80) | 70 (60–78) | 0.245 |
Use of medications | ||||
Levothyroxine, n (%) | 35 (40.2) | 64 (13.8) | 99 (17.9) | ≤0.001 |
Antidepressants, n (%) | 25 (28.7) | 157 (33.8) | 182 (33.0) | 0.360 |
Antipsychotics, n (%) | 34 (39.1) | 98 (21.1) | 132 (23.9) | ≤0.001 |
Anxiolytics, n (%) | 17 (19.5) | 54 (11.6) | 71 (12.9) | 0.043 |
“Non-psychiatric” medications, n (%) | 66 (75.9) | 229 (49.2) | 295 (53.4) | ≤0.001 |
Unadjusted OR (95% CI) |
p value | Adjusted OR (95% CI) |
p value | |
---|---|---|---|---|
Study groupsa
| ||||
Bipolar without lithium | 1 (ref) | 1 (ref) | ||
Bipolar with lithium | 23.96 (5.80, 99.00) | ≤0.001 | 13.45 (3.09, 58.55) | 0.001 |
Control population | 2.05 (0.36, 12.47) | 0.438 | 2.40 (0.38, 15.41) | 0.355 |
Age | – | 1.04 (1.02, 1.06) | ≤0.001 | |
Sex | – | 0.38 (0.19, 0.77) | 0.007 | |
Creatinine | – | 1.01 (0.99, 1.03) | 0.489 | |
Pathological TSH | – | 1.30 (0.63, 2.69) | 0.477 | |
Levothyroxine | – | 1.03 (0.46, 2.28) | 0.945 | |
Antidepressants | – | 0.38 (0.21, 0.67) | 0.001 | |
Antipsychotics | – | 1.88 (1.04, 3.04) | 0.036 | |
Anxiolytics | – | 1.66 (0.80, 3.45) | 0.174 | |
“Non-psychiatric” medications | – | 1.45 (0.75, 2.79) | 0.273 |
Case no. | Sex | Age | Lithium duration at operation | No. glands identified | No. glands extirpated | Morphology | PTH before surgery (ref: 10–73) | Phosphate before surgery (ref: ♀ 0.8–1.5, ♂ 0.7–1.6) | Ca (ref: 2.10–2.50) | Crea (ref: ♀ 45–90, ♂ 60–105) | Thyroid disease | Cure at initial operation | Follow-up | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Before | After | Before | After | ||||||||||||
1 | F | 65 | 28 | 3 | 1.5 | Normal | 106 | 0.99 | 2.73 | 2.47 | 92 | 77 | Nontoxic goitre | No | 12 years, recurrent |
2 | F | 74 | 34 | 4 | 3 | Hyperplasia | 170 | 0.92 | 2.79 | 2.45 | 78 | 69 | Multinodular goitre | No | 7 years, recurrent |
3 | F | 65 | 33 | 2 | 2 | Hyperplasia | 117 | 1.08 | 2.66 | 2.43 | 74 | 72 | None | No | 12 years, recurrent |
4 | M | 50 | 14 | 4 | 2 | Hyperplasia | 67 | n/a | 2.75 | 2.02 | 109 | 109 | Hypothyroidism | No | 12 years, recurrent |
5 | M | 55 | 29 | 2 | 1 | Lipoadenoma | 268 | 0.8 | 2.83 | 2.18 | 154 | 187 | None | No | 11 years, persistenta
|
6 | M | 62 | 36 | 2 | 1 | Adenoma | 102 | n/a | 2.69 | 2.47 | 107 | 111 | Hypothyroidism | No | 5 years, recurrent |
7 | F | 46 | 19 | 4 | 2.5 | Hyperplasia | 66 | n/a | 2.67 | 2.32 | 81 | 97 | Hypothyroidism | No | 11 years, recurrent |