Evidence map›Paper›PMID 41931247›Full record

ArticleInternational journal of bipolar disorders2026

Thyroid peroxidase antibodies in bipolar disorder: implications for clinical sub-phenotypes and lithium response.

Bishnu D Pathak, Mete Ercis, Melissa Solares-Bravo, Nik Ghafouri, Balwinder Singh, Aysegul Ozerdem, Jin Hong Park, Deniz Ceylan, Brandon J Coombes, Francisco Romo-Nava and 9 more

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Article in International journal of bipolar disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Bishnu D PathakDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Mete ErcisDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Melissa Solares-BravoDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Nik GhafouriDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Balwinder SinghDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Aysegul OzerdemDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Jin Hong ParkDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Deniz CeylanDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Brandon J CoombesDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Francisco Romo-NavaLindner Center of HOPE, Mason, OH, USA.
Marin VeldicDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Alfredo Cuellar-BarbozaDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Manuel Gardea-ResendezDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Matthew L BaumDepartment of Psychiatry, Mass General Brigham, Harvard Medical School, Boston, MA, USA.
Katherine E BurdickDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, USA.
Marius N StanDivision of Endocrinology, Nutrition and Metabolism, Mayo Clinic, Rochester, MN, USA.
Susan L McElroyLindner Center of HOPE, Mason, OH, USA.
Joanna M BiernackaDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Mark A FryeDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. mfrye@mayo.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundBipolar disorder (BD) is a heterogeneous psychiatric disorder that is increasingly recognized as having immune-inflammatory pathogenesis. Previous studies have shown thyroid autoimmunity, in particular, thyroid peroxidase antibody (TPO-Ab), is associated with rapid cycling and antidepressant-induced mania in BD. We examined the relationship between TPO-Ab seropositivity and BD clinical sub-phenotypes and lithium response.

methodsIn this cross-sectional study, adult patients with BD enrolled in the Mayo Clinic BD Biobank were stratified into TPO-Ab positive versus negative groups using all available information (research data and electronic health records). Multivariable logistic regression analyses were conducted to assess associations between TPO-Ab status and clinical sub-phenotypes, including early age at onset, history of psychosis, rapid cycling, suicide attempt, and antidepressant-induced mania. Linear regression was used to examine associations with lithium treatment response (Alda A score). All models were adjusted for age, sex, BMI, and laboratory data source for TPO-Ab values.

resultsAmong 339 individuals (mean age = 43.8 ± 15.2 years, 61.1% female), 23.9% were TPO-Ab positive. In adjusted models, TPO-Ab positivity was associated with reduced odds of history of psychosis (OR = 0.49, 95% CI 0.27–0.87, p = 0.017) and poorer treatment response to lithium (β = -0.92, 95% CI -1.74 – -0.11, p = 0.026). In exploratory analyses, no significant interactions of TPO-Ab status with age and sex were observed across different sub-phenotypes.

conclusionsOur findings suggest that thyroid autoimmunity is associated with a distinct BD phenotype characterized by less psychosis and a poor response to lithium treatment. Future prospective longitudinal studies should validate these findings in larger cohorts and investigate underlying biological mechanisms by incorporating thyroid function status, thyroid antibody dynamics, and broader autoantibody proteome.

Indexed as

AutoantibodiesBipolar disorderLithiumPsychosisThyroid

Identifiers

PMID41931247
PMCPMC13172239

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