quetiapine-fumarate and Hypothyroidism

Thyroid abnormalities are documented consequences of quetiapine treatment. This may have clinical implications as changes in thyroid hormones may deteriorate a person's affective state. Yet less is known about the clinical factors and underlying mechanisms associated with thyroid hormones on quetiapine therapy. We therefore systematically reviewed the published literature of evidence of quetiapine-induced thyroid abnormalities. We searched MEDLINE, PsycINFO, Google Scholar, and EMBASE for articles in which individuals developed biochemically confirmed thyroid abnormalities (with or without clinical symptoms) while on quetiapine treatment. We included case reports, case series, observational, and experimental studies. We included 32 studies, 20 of which were observational and experimental studies. There were 10 case reports and 1 case series. All the research designs suggested an association between quetiapine and hypothyroidism. However, these findings were limited by the quality of the included studies and the general lack of either a clear temporal relationship or dose response. Quetiapine has been associated with thyroid abnormalities, mainly with hypothyroidism. Drug imputability in these abnormalities is not always clear, and the underlying pathophysiology may include immunological and nonimmunological mechanisms. Large prospective studies are required to clarify this association and to further inform the management of patients treated with quetiapine where hypothyroidism occurs.

Topics: Age Factors; Humans; Hypothyroidism; Quetiapine Fumarate; Sex Factors; Sociodemographic Factors; Thyroid Diseases; Thyroid Function Tests; Thyroid Gland

A woman in her twenties was admitted to the psychiatric ward with suspected psychosis. Routine tests revealed a rare and potentially dangerous cause of her symptoms.. The patient had a history of bipolar II disorder, recurrent depressive disorder and hypothyroidism, and presented to the psychiatric emergency department with a one-week history of delusions of persecutory character and increasing insomnia. She had given birth four months prior to admission. Clinical examination was otherwise unremarkable. Bipolar psychosis was considered the most likely diagnosis, and she was started on antipsychotic medication with quetiapine 100 mg × 2. Routine blood tests revealed severe hypothyroidism with thyroid stimulating hormone (TSH) of 151,00 mIU/L and free T4 (fT4) of <3,0 pmol/L (9,5-22,0), and the patient was treated with a high dose of oral levothyroxine. After a few days the patient's psychiatric symptoms resolved completely, and her fT4 increased to 10,8 pmol/L. Upon further questioning, the patient admitted to increasing fatigue and constantly feeling cold over the previous few months, which she attributed to being a parent. She was discharged after a week without any psychiatric symptoms.. This case report highlights the importance of a broad somatic differential diagnostic approach to patients with psychosis.

Topics: Antipsychotic Agents; Delusions; Female; Humans; Hypothyroidism; Quetiapine Fumarate; Thyrotropin; Thyroxine

To assess association between quetiapine treatment and risk of new-onset hypothyroidism in schizophrenia patients.. We conducted a retrospective cohort study in a tertiary hospital in China between January 2016 and December 2018. Schizophrenia patients with normal thyroid tests at admission were included. Hypothyroidism, which was defined as thyroid-stimulating hormone >4.20 mU/L and free thyroxine <12.00 pmol/L, or on L-thyroxine prescriptions, was the outcome measure, and quetiapine treatment between admission and subsequent thyroid test was the exposure measure of this study. Adjusted relative risks and 95% confidence intervals were used to assess the independent association of quetiapine treatment with risk of new-onset hypothyroidism. The dose-response association was further analysed by 3 quetiapine doses: low (≤<=0.2 g/d), medium (0.2-0.6 g/d), and high (>0.6 g/d).. A total of 2022 eligible patients were included in the final analysis. Sixty patients (15.0%) in the quetiapine group developed hypothyroidism, while 56 patients (3.5%) in the nonquetiapine group developed hypothyroidism. Relative risk (95% confidence interval) of developing hypothyroidism for quetiapine use was 4.01 (2.86-5.64) after adjusting for several potential confounding factors. A strong dose-response association between quetiapine use and risk of developing hypothyroidism was observed: adjusted relative risks (95% confidence intervals) were 1.00 (0.25-2.59), 4.22 (2.80-6.25) and 5.62 (3.66-8.38), respectively, for low-, medium- and high-dose quetiapine, as compared with no quetiapine.. Acute phase quetiapine treatment for schizophrenia patients was strongly associated with increased risk of developing new-onset hypothyroidism, with a clear dose-response association.

Topics: Humans; Hypothyroidism; Quetiapine Fumarate; Retrospective Studies; Schizophrenia; Thyroxine

Hypothyroidism has been associated with quetiapine, but the underlying mechanism is not well understood and has been presumed to result from thyroid gland dysfunction (primary hypothyroidism). We present a case of symptomatic quetiapine-induced hypothyroidism due to hypothalamic/pituitary gland dysfunction (central [secondary] hypothyroidism).

Topics: Humans; Hypothyroidism; Quetiapine Fumarate

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Lamotrigine; Maternal-Fetal Exchange; Phenobarbital; Pregnancy; Pregnancy Complications; Quetiapine Fumarate; Substance Withdrawal Syndrome; Triazines

Topics: Adolescent; Antipsychotic Agents; Dibenzothiazepines; Female; Hormone Replacement Therapy; Humans; Hypothyroidism; Quetiapine Fumarate; Thyrotropin; Thyroxine; Treatment Outcome; Young Adult

Late-onset bipolar disorder is rare and can be precipitated by organic brain disorders. While the association between hyperthyroidism and mania is well described, mania or hypomania precipitated by hypothyroidism is rare. The authors present late-onset bipolar disorder in a 72-year-old woman presenting with mania and psychosis, which appear to have been precipitated by autoimmune hypothyroidism. This case shows the importance of ascertaining the thyroid status in patients with mood and psychotic disorders, especially in elderly patients and in patients lacking prominent signs of thyroid disease.

Topics: Aged; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Female; Humans; Hypothyroidism; Psychotic Disorders; Quetiapine Fumarate; Thyroxine

Topics: Antipsychotic Agents; Depressive Disorder, Major; Dibenzothiazepines; Drug Monitoring; Female; Humans; Hypothyroidism; Middle Aged; Quetiapine Fumarate; Thyroid Hormones

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Hypothyroidism; Psychotic Disorders; Quetiapine Fumarate

Topics: Antipsychotic Agents; Dibenzothiazepines; Double-Blind Method; Humans; Hyperthyroidism; Hypothyroidism; Placebos; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Risperidone; Schizophrenia; Thyroid Function Tests; Thyroid Hormones

Topics: Adolescent; Antipsychotic Agents; Dibenzothiazepines; Humans; Hypothyroidism; Intellectual Disability; Male; Mental Disorders; Quetiapine Fumarate; Thyroid Function Tests

To report a case of hypothyroidism occurring after the addition of quetiapine to an existing drug regimen.. A 46-year-old African-American woman diagnosed with schizoaffective disorder, bipolar type, and a four-year history of successfully treated hyperthyroidism, was suboptimally responsive to olanzapine treatment. Transition from olanzapine to quetiapine was initiated and, approximately two months after adding quetiapine to a standing pharmacotherapeutic regimen, the patient developed an elevated thyroid-stimulating hormone (TSH) concentration of 8.45 microU/L. A diagnosis of hypothyroidism was subsequently made, treatment with levothyroxine was initiated, and the patient's thyroid function became stable.. Drug induced hypothyroidism is known to occur with several medications. Quetiapine is an atypical antipsychotic with the potential to decrease thyroid hormone concentrations in some patients; this effect may be dose related. Despite this known adverse effect, the manufacturer of quetiapine reports that elevated TSH concentrations and subsequent treatment with thyroid hormone supplementation have occurred only rarely. We report the development of hypothyroidism in a patient who had previously received successful radioactive iodine treatment for hyperthyroidism in 1994, but who had no detected thyroid abnormalities until treatment with quetiapine was started four years later.. Patients with compromised thyroid function who receive treatment with quetiapine may develop hypothyroidism. Appropriate care for these patients may include an increased awareness of possible hypothyroidism and consideration of thyroid function monitoring.

Topics: Antipsychotic Agents; Dibenzothiazepines; Female; Humans; Hypothyroidism; Male; Middle Aged; Quetiapine Fumarate; Thyroid Function Tests