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SO483

Lithium and the Parathyroid: Risk, Reversibility, and Recurrence

LITHIUM AND THE PARATHYROID: RISK, REVERSAL, AND RECURRENCE

Lithium treatment substantially increases the risk of hyperparathyroidism, which typically develops after long-term use and frequently recurs following intervention.

The study aimed to investigate the risk factors and clinical outcomes of lithium-associated hypercalcemia and hyperparathyroidism (HPT), including the roles of lithium levels and treatment duration. As part of LiSIE (Lithium Study into Effects and Side Effects), a retrospective cohort study conducted in the Norrbotten region of Sweden, medical records from 1997 to 2017 were reviewed for 1,562 patients with bipolar disorder or schizoaffective disorder. HPT episodes were analyzed by sex, age, and whether any therapeutic intervention had been undertaken. The incidence of HPT among lithium users was 4.0 per 1,000 person-years, compared with 0.21 in the reference population, corresponding to a 12.4-fold higher risk (3.95 versus 0.21 in the abstract; p < 0.0001). The median age of patients with HPT was 58 years, and 83% were women; the median time from lithium initiation to HPT onset was 8 years (range, 0.1–18 years). A statistically significant association was found between serum lithium and calcium levels (p < 0.01), but its explanatory power was very low (R-squared = 0.02), and no clear association was demonstrated between serum lithium concentration and HPT risk. Only 27% of the 41 patients diagnosed with HPT underwent an intervention (surgery, lithium discontinuation, or treatment with a calcimimetic agent), and those receiving an intervention were predominantly women. Over a median follow-up of 3 years, the recurrence rate was 55%, while two-thirds of those who discontinued lithium experienced no recurrence. Restarting lithium was associated with rapid recurrence in at least one case. The authors recommend regular monitoring of calcium and parathyroid hormone levels in lithium users, with particular attention to older patients, women, and those with long-term lithium exposure, and consideration of individualized management strategies.

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