Anticonvulsants and thyroid function.

Yeo, P. P. B.; Bates, D; Howe, J G; Ratcliffe, W. A.; Schardt, Cordula; Heath, Agiua; Evered, David

doi:10.1136/bmj.1.6127.1581

Cited by 66 publications

(19 citation statements)

References 17 publications

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“…Our results are in agreement with other studies demonstrating decreasing serum total T4 levels in patients under CBZ treatment [t, 11,20]. Another antiepileptic drug, such as DPH, is known to lower T4 and FT4 serum concentrations, by accelerating the thyroxine peripheral metabolism, via both faecal and deiodinative routes [3,4,[7][8][9][10]12].…”

Section: Discussionsupporting

confidence: 95%

“…Abbreviations: CBZ = carbamazepine; DPH = phentoin; T4 = thyroxine; T3 = triiodothyronine; TSH = thyrotropin; FT 4 = free T4; FT3 = free T3; rT3 = reverse T3 TBG = thyroxine binding globulin; T3U = T3 uptake; RIA = radioimmunoassay (TSH) levels or the thyroid status [3,8,11,17,20]. Only two epileptic adults on long-term treatment (by CBZ the first, by the combined CBZ and DPH regimen the second) developed hypothyroidism which reverted after anti-convulsivant withdrawal [1].…”

Section: Introductionmentioning

confidence: 99%

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Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

et al. 1986

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In five L-thyroxine-substituted hypothyroid children with partial epilepsy serum total thyroxine (T4) and free T4 (FT4) significantly (P less than 0.01) decreased following 2 months of carbamazepine (CBZ) administration (20 mg/kg per BW per day) from mean (+/- SD) values of 12.7 +/- 1.1 micrograms/dl and 15.5 +/- 1.8 pg/ml to mean values of 7.5 +/- 2.3 and 10.1 +/- 1.7, respectively. In all but one patient important changes in both serum total and free triiodothyronine (T3, FT3) were not observed; consequently T3:T4 and FT3:FT4 ratios significantly (P less than 0.05) increased in the whole series. Three subjects had post-treatment serum TSH that rose to hypothyroid levels parallel to a T4 decrease. The negligible thyroid hormone secretion and the unmodified T3-uptake (T3U) or T4-binding globulin (TBG) exclude direct effects of CBZ on thyroid gland and on carrier serum proteins, respectively. The findings observed, instead, might be due to accelerated T4 metabolic clearance together with augmented T4 to T3 conversion rate, as previously demonstrated for diphenylhydantoin. The sharp reduction in T4 and FT3 concentrations is the peripheral display of this event, which is associated with a decompensation of the metabolic status, as indicated by serum TSH enhancement. In all cases a supplement of L-thyroxine by itself was able to restore euthyroid TSH serum concentrations, suggesting that hypothyroidism in patients with partial epilepsy to whom CBZ had been administered requires a higher L-T4 substitutive regimen.

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Section: Discussionsupporting

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

et al. 1986

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“…There have been a number of studies of the effects on thyroid function of CBZ, both alone (1 2-30) and in combination with other drugs (13, 15,18,19,26,29,31), and some of these studies were prospective (1 5,22,23,26,28, 32). However, most of these studies have been of adults, and only a few exclusively considered children (12,13, 25,29,30).…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Treatment of Children with Epilepsy with Valproate or Carbamazepine May Cause Subclinical Hypothyroidism

Eirís-Puñal¹,

Río-Garma²,

Río-Garma

et al. 1999

Epilepsia

103

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Summary:Purpose: The aim of the study was to evaluate serum thyroid hormone balance in children receiving long-term therapy with carbamazepine (CBZ), valproate (VPA), and phenobarbital (PB).Methods: We determined serum levels of triiodothyronine (TJ, thyroxine (TJ, free thyroxine (FT,), thyroxine-binding globulin (TBC), and thyroid-stimulating hormone (TSH) in 148 healthy children and 141 children with epilepsy who had been receiving CBZ (61 patients), VPA (51 patients), or PB (29 patients) for 12-161 months. In view of TSH values, three categories of subclinical hypothyroidism were considered: I, TSH greater than the control-group mean + 2 SD (4.37 mIUL in our study) and <6 mIU/L; 11, TSH between 6 and 12 mIUL; and 111, TSH >I2 mIU/L.Results: In all treated groups, mean T, and f14 levels were lower than in the control group, whereas the CBZ-and VPAtreated children additionally showed reduced mean T, and TBC levels and increased mean TSH levels. In the group receiving CBZ, 8.2% had TSH values higher than the normalrange maximum, by comparison with only 3.6% of healthy children. The increase in TSH levels was particularly marked in VPA-treated children, accounting for 26% of patients with subclinical hypothyroidism. Conclusions: Our results, in contrast to previous reports, suggest that CBZ and particularly VPA may induce subclinical hypothyroidism. This suggests a need for careful monitoring of TSH levels in children receiving CBZ or VPA.

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“…Our study demonstrate that phenytoin treated patients shows increase serum concentration of TSH whereas T3, T4 in normal range this was in contrast to the study conducted by Yeo and Bates in 1978 which showed decreased T3, T4 with phenytoin and other studies which showed TSH to be within normal reference range. [17][18][19] This may be due to its enzyme induction property, which accelerate the hormone clearance. In our study carbamazepine treated patients showed decrease serum concentration of T3, T4 whereas TSH remains within in normal range.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of thyroid status of patients on phenytoin, carbamazepine and valproate monotherapy

Dhodi

Bhagat

Patil

2016

Int J Basic Clin Pharmacol

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Anticonvulsants and thyroid function.

Cited by 66 publications

References 17 publications

Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

Changes in thyroid function tests induced by 2 month carbamazepine treatment in l-thyroxine-substituted hypothyroid children

Long‐Term Treatment of Children with Epilepsy with Valproate or Carbamazepine May Cause Subclinical Hypothyroidism

A comparative study of thyroid status of patients on phenytoin, carbamazepine and valproate monotherapy

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