Patients who are to start lithium treatment should have baseline measures of renal, thyroid and parathyroid function as well as regular long-term monitoring, conclude the authors of a new study. In their retrospective analysis, Shine et al. found that lithium use was associated with increased risks of stage 3 chronic kidney disease (HR 1.93, 95% CI 1.76–2.12), hypothyroidism (HR 2.31, 95% CI 2.05–2.60), and hypercalcaemia (HR 1.43, 95% CI 1.21–1.69). Women had a higher risk of renal and thyroid disorders than did men, with younger women at higher risk than older women.