Abstract：
OBJECTIVE: This study aims to estimate the prevalence of and determine physician approaches to the screening and management of lithium-associated thyroid and parathyroid disorders in British Columbia, Canada.
METHODS: Serum lithium and thyroid/parathyroid laboratory data were collected retrospectively for patients with lithium levels measured at seven BC hospitals between 2012 and 2021. A mail-out survey about screening and management of thyroid/parathyroid disorders in patients on lithium was sent to the ordering physicians of patients with abnormal results. Three months after, a follow-up questionnaire was sent to respondents, and the original survey was re-sent to non-responders.
RESULTS: Of 4917 patients, 1.9 % had PTH (mean 22.33 ± 23.00 pmol/L) and 77.1 % had TSH (mean 3.61 ± 6.69 pmol/L) measured. Of 222 hypercalcemic patients (defined as any serum calcium or ionized calcium above the laboratory reference), 17.6 % had a PTH level measured. From 294 surveys sent to 214 physicians, the overall response rate was 31.6 % (n = 93) with twelve fully completed surveys. All twelve respondents monitored TSH levels every 6-12 months, and eight physicians monitored PTH and/or calcium at variable intervals. Two physicians routinely ordered both thyroid and parathyroid screening laboratory tests. Of the 80 non-respondents, limited patient contact was the most common reason for opting out (n = 27).
CONCLUSIONS: Our results suggest biochemical screening for lithium-associated parathyroid disorders is less common than for thyroid disorders. There is insufficient data to determine the true prevalence of lithium-associated thyroid and parathyroid disorders. This highlights the need for updated clinical guidelines for management of lithium-associated thyroid and parathyroid disorders.
METHODS: Serum lithium and thyroid/parathyroid laboratory data were collected retrospectively for patients with lithium levels measured at seven BC hospitals between 2012 and 2021. A mail-out survey about screening and management of thyroid/parathyroid disorders in patients on lithium was sent to the ordering physicians of patients with abnormal results. Three months after, a follow-up questionnaire was sent to respondents, and the original survey was re-sent to non-responders.
RESULTS: Of 4917 patients, 1.9 % had PTH (mean 22.33 ± 23.00 pmol/L) and 77.1 % had TSH (mean 3.61 ± 6.69 pmol/L) measured. Of 222 hypercalcemic patients (defined as any serum calcium or ionized calcium above the laboratory reference), 17.6 % had a PTH level measured. From 294 surveys sent to 214 physicians, the overall response rate was 31.6 % (n = 93) with twelve fully completed surveys. All twelve respondents monitored TSH levels every 6-12 months, and eight physicians monitored PTH and/or calcium at variable intervals. Two physicians routinely ordered both thyroid and parathyroid screening laboratory tests. Of the 80 non-respondents, limited patient contact was the most common reason for opting out (n = 27).
CONCLUSIONS: Our results suggest biochemical screening for lithium-associated parathyroid disorders is less common than for thyroid disorders. There is insufficient data to determine the true prevalence of lithium-associated thyroid and parathyroid disorders. This highlights the need for updated clinical guidelines for management of lithium-associated thyroid and parathyroid disorders.
摘要：
目的：本研究旨在评估不列颠哥伦比亚省锂相关甲状腺和甲状旁腺疾病的患病率并确定医师筛查和管理的方法。加拿大。
方法：回顾性收集了2012年至2021年在7家BC医院测量锂水平的患者的血清锂和甲状腺/甲状旁腺实验室数据。有关锂患者甲状腺/甲状旁腺疾病筛查和管理的邮件调查已发送给结果异常患者的订购医师。三个月后,向受访者发送了一份后续调查问卷，最初的调查被重新发送给无应答者。
结果：在4917名患者中，1.9%有PTH(平均22.33±23.00pmol/L),77.1%有TSH(平均3.61±6.69pmol/L)。222名高钙血症患者（定义为高于实验室参考的任何血清钙或离子钙），17.6%的人测量了PTH水平。从发给214名医生的294份调查中，在12项完全完成的调查中，总有效率为31.6%(n=93)。所有12名受访者每6-12个月监测TSH水平，8名医生以不同的间隔监测PTH和/或钙。两名医生常规要求进行甲状腺和甲状旁腺筛查实验室检查。在80名非答复者中，患者接触受限是选择退出的最常见原因(n=27).
结论：我们的结果表明，生化筛查锂相关甲状旁腺疾病不如甲状腺疾病。没有足够的数据来确定锂相关甲状腺和甲状旁腺疾病的真实患病率。这突出了需要更新锂相关甲状腺和甲状旁腺疾病治疗的临床指南。
方法：回顾性收集了2012年至2021年在7家BC医院测量锂水平的患者的血清锂和甲状腺/甲状旁腺实验室数据。有关锂患者甲状腺/甲状旁腺疾病筛查和管理的邮件调查已发送给结果异常患者的订购医师。三个月后,向受访者发送了一份后续调查问卷，最初的调查被重新发送给无应答者。
结果：在4917名患者中，1.9%有PTH(平均22.33±23.00pmol/L),77.1%有TSH(平均3.61±6.69pmol/L)。222名高钙血症患者（定义为高于实验室参考的任何血清钙或离子钙），17.6%的人测量了PTH水平。从发给214名医生的294份调查中，在12项完全完成的调查中，总有效率为31.6%(n=93)。所有12名受访者每6-12个月监测TSH水平，8名医生以不同的间隔监测PTH和/或钙。两名医生常规要求进行甲状腺和甲状旁腺筛查实验室检查。在80名非答复者中，患者接触受限是选择退出的最常见原因(n=27).
结论：我们的结果表明，生化筛查锂相关甲状旁腺疾病不如甲状腺疾病。没有足够的数据来确定锂相关甲状腺和甲状旁腺疾病的真实患病率。这突出了需要更新锂相关甲状腺和甲状旁腺疾病治疗的临床指南。
