Question

scenario: a patient with bipolar disorder has been stable on lithium for several years but now presents with symptoms of hypothyroidism.
question: what should be done according to apa guidelines?

• discontinue lithium.
• add thyroid hormone replacement therapy.
• switch to valproate.
• reduce the dose of lithium.

Explanation:

According to APA (American Psychiatric Association) guidelines, when a patient on lithium (for bipolar disorder) develops hypothyroidism, the recommended approach is to add thyroid hormone replacement therapy (like levothyroxine) rather than discontinuing lithium (which is effective for bipolar), switching to another agent without indication, or reducing lithium dose (as hypothyroidism is a manageable side - effect with hormone replacement while maintaining lithium's therapeutic effect for bipolar). Discontinuing lithium can risk bipolar relapse, switching to valproate is not indicated just for hypothyroidism, and reducing lithium dose may compromise bipolar stability.

Answer:

B. Add thyroid hormone replacement therapy.