Unraveling the Diagnostic Implications of Elevated Prealbumin Levels in Lithium-Induced Hypothyroidism: A Case Report


Authors : Hamza Oualhadj; Nouhaila Moustahfid; Ayoub Rafei; Saliha Chelak; Abderrahmane Boukhira

Volume/Issue : Volume 9 - 2024, Issue 5 - May

Google Scholar : https://tinyurl.com/wvujf4k9

Scribd : https://tinyurl.com/ypabdt4r

DOI : https://doi.org/10.38124/ijisrt/IJISRT24MAY2230

Abstract : Prealbumin, a multifunctional protein synthesized primarily in the liver, serves as a critical biomarker in clinical practice, offering insights into nutritional status and prognostic outcomes. While its precise physiological role remains incompletely understood, prealbumin is known to facilitate hormone transport, particularly of thyroxine, and contribute to neuroprotection. Clinically, prealbumin levels are sensitive indicators of recent changes in protein intake and absorption, making them invaluable in guiding therapeutic interventions. Alterations in prealbumin levels have been associated with various medical conditions, including chronic kidney disease, liver disease, and cancer, emphasizing its prognostic significance across diverse clinical contexts. we report a case of a 42-year-old male with bipolar disorder managed on lithium therapy, presenting with depressive symptoms and unexpected hyperprealbuminemia. Subsequent investigation revealed primary hypothyroidism secondary to lithium intoxication, highlighting the intricate relationship between lithium therapy, prealbumin levels, and thyroid dysfunction. We discuss the mechanisms and clinical implications of lithium-induced hypothyroidism, emphasizing the importance of considering thyroid function in patients with elevated prealbumin levels. This case underscores the necessity for vigilant monitoring and timely intervention to optimize patient outcomes in cases of lithium-induced thyroid dysfunction. Continued research is crucial for elucidating the complex interactions between prealbumin, lithium therapy, and thyroid function, enhancing our understanding and management of these metabolic disturbances.

Keywords : Elevated Prealbumin; Lithium-Induced Hypothyroidism; Biomarkers; Clinical Implications.

References :

  1.  Ranasinghe, R.N.K., Biswas, M., Vincent, R.P.: Prealbumin: The clinical utility and analytical methodologies, (2022)
  2. Liz, M.A., Coelho, T., Bellotti, V., Fernandez-Arias, M.I., Mallaina, P., Obici, L.: A Narrative Review of the Role of Transthyretin in Health and Disease, (2020)
  3. Keller, U.: Nutritional laboratory markers in malnutrition. J Clin Med. 8, (2019). https://doi.org/10.3390/jcm8060775
  4. Wei, J., Jin, M., Shao, Y., Ning, Z., Huang, J.: High preoperative serum prealbumin predicts long-term survival in resected esophageal squamous cell cancer. Cancer Manag Res. 11, 7997–8003 (2019). https://doi.org/10.2147/CMAR.S214037
  5. Aoyama, T., Nakazono, M., Segami, K., Nagasawa, S., Kano, K., Hara, K., Maezawa, Y., Hashimoto, I., Suematsu, H., Watanabe, H., Komori, K., Tamagawa, H., Yukawa, N., Rino, Y., Ogata, T., Oshima, T.: Clinical Significance of the Prealbumin Level in Gastric Cancer Patients Who Receive Curative Treatment. J Gastrointest Cancer. 54, 27–34 (2023). https://doi.org/10.1007/s12029-021-00777-w
  6. Jeznach-Steinhagen, A., Boniecka, I., Rymarz, A., Staszków, M., Romaszko, J., Czerwonogrodzka-Senczyna, A.: Higher Muscle Mass and Higher Serum Prealbumin Levels Are Associated with Better Survival in Hemodialysis Patients during a Five-Year Observation Period. Nutrients. 15, (2023). https://doi.org/10.3390/nu15051237
  7. Hamilton, J.A., Benson, M.D.: Transthyretin: a review from a structural perspective.
  8. Shenkin, A.: Serum prealbumin: Is it a marker of nutritional status or of risk of malnutrition?, (2006)
  9. Wang, W., Pan, Y., Tang, X., Hao, G., Xie, Y., Ma, S., Luo, J., Guo, D., Ding, F.: Serum prealbumin and its changes over time are associated with mortality in acute kidney injury. Sci Rep. 7, (2017). https://doi.org/10.1038/srep41493
  10. Cui, N., Tong, H., Li, Y., Ge, Y., Shi, Y., Lv, P., Zhao, X., Zhang, J., Fu, G., Zhou, Y., Jiang, K., Lin, N., Bai, T., Jin, R., Wei, S., Yang, X., Li, X.: Role of prealbumin in predicting the prognosis of severely and critically ill COVID-19 patients. American Journal of Tropical Medicine and Hygiene. 105, 718–725 (2021). https://doi.org/10.4269/ajtmh.21-0234
  11. ÖZTÜRK, A., DEMİRCİ, G.: Serum prealbumin levels and their association with serum albumin, calcium, magnesium, and phosphorus concentrations. Journal of Medicine and Palliative Care. 4, 412–417 (2023). https://doi.org/10.47582/jompac.1346527
  12. Lee, J.L., Oh, E.S., Lee, R.W., Finucane, T.E.: Serum Albumin and Prealbumin in Calorically Restricted, Nondiseased Individuals: A Systematic Review. American Journal of Medicine. 128, 1023.e1-1023.e22 (2015). https://doi.org/10.1016/j.amjmed.2015.03.032
  13. Scanlan, R., Jones, T., Pellicane, A.J., Oswald, M.C., Do, K.D., Roth, E.J.: Prealbumin Study. J Am Diet Assoc. 110, A34 (2010). https://doi.org/10.1016/j.jada.2010.06.125
  14. Chiang, H.-C., Lin, M.-Y., Lin, F.-C., Chiang, N.-J., Wang, Y.-C., Lai, W.-W., Chang, W.-L., Sheu, B.-S.: Transferrin and Prealbumin Identify Esophageal Cancer Patients with Malnutrition and Poor Prognosis in Patients with Normal Albuminemia: A Cohort Study. Nutr Cancer. 74, 3546–3555 (2022). https://doi.org/10.1080/01635581.2022.2079687
  15. Sun, D. wei, An, L., Lv, G. yue: Albumin-fibrinogen ratio and fibrinogen-prealbumin ratio as promising prognostic markers for cancers: An updated meta-analysis, (2020)
  16. Jeejeebhoy, K.N.: Nutritional Assessment. In: Johnson, L.R. (ed.) Encyclopedia of Gastroenterology. pp. 759–766. Elsevier, New York (2004)
  17. Kinoshita, H., Yasuda, M., Mori, M., Yakushiji, F.: Elevated prealbumin level following high thyroid hormones levels. Endocrinology Studies. 3, 4 (2013). https://doi.org/10.4081/es.2013.e4
  18. Kibirige, D., Luzinda, K., Ssekitoleko, R.: Spectrum of lithium induced thyroid abnormalities: A current perspective, (2013)
  19. Czarnywojtek, A., Zgorzalewicz-Stachowiak, M., Czarnocka, B., Sawicka-Gutaj, N., Gut, P., Krela-Kazmierczak, I., Ruchala, M.: Effect of lithium carbonate on the function of the thyroid gland: Mechanism of action and clinical implications, (2020)
  20. Kraszewska, A., Ziemnicka, K., Jończyk-Potoczna, K., Sowiński, J., Rybakowski, J.K.: Thyroid structure and function in long-term lithium-treated and lithium-naïve bipolar patients. Hum Psychopharmacol. 34, (2019). https://doi.org/10.1002/hup.2708
  21. Arathil, P., Mathew, K., Narayanan, D.: Lithium-induced thyroiditis in a patient having bipolar affective disorder - A rare case report. Indian J Psychol Med. 40, 577–579 (2018). https://doi.org/10.4103/IJPSYM.IJPSYM_403_17
  22. Vantyghem, M., Marie-Christine, P.: Iatrogenic endocrine complications of lithium therapy Iatrogénie endocrinienne du lithium. (2023)  

Prealbumin, a multifunctional protein synthesized primarily in the liver, serves as a critical biomarker in clinical practice, offering insights into nutritional status and prognostic outcomes. While its precise physiological role remains incompletely understood, prealbumin is known to facilitate hormone transport, particularly of thyroxine, and contribute to neuroprotection. Clinically, prealbumin levels are sensitive indicators of recent changes in protein intake and absorption, making them invaluable in guiding therapeutic interventions. Alterations in prealbumin levels have been associated with various medical conditions, including chronic kidney disease, liver disease, and cancer, emphasizing its prognostic significance across diverse clinical contexts. we report a case of a 42-year-old male with bipolar disorder managed on lithium therapy, presenting with depressive symptoms and unexpected hyperprealbuminemia. Subsequent investigation revealed primary hypothyroidism secondary to lithium intoxication, highlighting the intricate relationship between lithium therapy, prealbumin levels, and thyroid dysfunction. We discuss the mechanisms and clinical implications of lithium-induced hypothyroidism, emphasizing the importance of considering thyroid function in patients with elevated prealbumin levels. This case underscores the necessity for vigilant monitoring and timely intervention to optimize patient outcomes in cases of lithium-induced thyroid dysfunction. Continued research is crucial for elucidating the complex interactions between prealbumin, lithium therapy, and thyroid function, enhancing our understanding and management of these metabolic disturbances.

Keywords : Elevated Prealbumin; Lithium-Induced Hypothyroidism; Biomarkers; Clinical Implications.

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