Thyroid Function in Girls with Epilepsy with Carbamazepine, Oxcarbazepine, or Valproate Monotherapy and after Withdrawal of Medication

Vainionpää, Leena; Mikkonen, Kirsi; Rättyä, Johanna; Knip, Mikael; Pakarinen, Arto; Myllylä, Vilho V.; Isojärvi, Jouko

doi:10.1111/j.0013-9580.2004.26003.x

Cited by 114 publications

(141 citation statements)

References 27 publications

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“…These data are in agreement with previous papers that found normal thyroid hormone levels (19,20,25,(28)(29)(30). By contrast, other studies (11,31) found normal thyroid hormone levels while TSH levels were increased. In a recent study, 36 out of 143 patients had TSHO5 m IU/l (index of subclinical hypothyroidism) during VPA treatment: 10 out of these patients also had low fT 4 levels; 9 out of these 36 patients had clinical symptoms of hypothyroidism but they are considered to have subclinical hypothyroidism because of high TSH values (32).…”

Section: Discussionsupporting

confidence: 93%

“…These results suggest that the changes in serum fT 4 levels are reversible. Our experience of 5 patients who have withdrawn CBZ-therapy is in agreement with previous reports (27,11).…”

Section: Discussionsupporting

confidence: 92%

“…Different thyroid dysfunctions have been reported in epileptic patients receiving VPA. In particular, reports on the effect of VPA on the thyroid hormones balance are conflicting, and both low and unchanged serum thyroxine (T 4 ) and free thyroxine (fT 4 ) levels have been found in patients receiving VPA monotherapy, never associated with overt thyroid dysfunction (9)(10)(11)(12)(13)(14): these studies showed normal mean TSH serum levels while other studies documented high TSH levels in patients receiving VPA therapy (10)(11)(12). However, the majority of studies have been performed in adult patients receiving these drugs, often in association with other AEDs.…”

Section: Introductionmentioning

confidence: 99%

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Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Verrotti

Laus

Sereno

et al. 2009

European Journal of Endocrinology

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Objective: This study evaluates the effects of long-term carbamazepine (CBZ) and valproate acid (VPA) therapy on thyroid function in epileptic children. Design: A prospective study performed in 32 newly diagnosed pediatric patients, subdivided into two groups: 18 patients treated with CBZ and 14 patients treated with VPA. Thirty-two sex-and agematched subjects served as controls. Methods: Serum TSH, thyroxine (T 4 ), triiodothyronine (T 3 ), free thyroxine (fT 4 ), free triiodothyronine (fT 3 ), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (TG-Ab) were evaluated at baseline and at the 3rd, 6th, and 12th month in all patients and in the control group. A TRH stimulation test was performed in all epileptic patients at baseline and at the 3rd, 6th, and 12th month evaluations while in controls only baseline assessment was carried out. Results: At baseline evaluation, thyroid function was normal in all epileptic children. After 3 months, CBZ-treated patients showed serum T 4 and fT 4 levels significantly lower than baseline evaluation and control subjects. Serum T 4 and fT 4 concentrations were unaffected by VPA monotherapy. Serum T 3 and fT 3 were normal in both CBZ-treated and VPA-treated patients. TRH test was normal in all patients. At 6th and 12th month evaluations, the same alterations were present in CBZ-treated patients while thyroid function remained normal in VPA-treated patients. TRH test responses were normal in all epileptic patients. TPO-Ab and TG-Ab were always absent in all patients. Conclusions: Our data suggest that VPA monotherapy does not alter thyroid hormones. On the contrary, alterations of thyroid hormones occur in CBZ-treated children. However, the patients are euthyroid and thyroid hormone alterations are not associated with clinical or subclinical hypothyroidism.

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Section: Discussionsupporting

confidence: 93%

“…These results suggest that the changes in serum fT 4 levels are reversible. Our experience of 5 patients who have withdrawn CBZ-therapy is in agreement with previous reports (27,11).…”

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Verrotti

Laus

Sereno

et al. 2009

European Journal of Endocrinology

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“…28,29 Valproate on the other side showed no significant change in the serum T3, T4 and TSH concentration, this results were in consistent with the other studies reported earlier in contrast other studies found normal thyroid hormone levels while TSH levels were increased. [30][31][32][33][34] This may be due to CBZ and Phenytoin induces hepatic microsomal enzymes markedly in dose-dependent fashion whereas VAL has no significant effect.…”

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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“…Há poucos dados disponíveis na literatura sobre potenciais interações do topiramato, gabapentina, felbamato, pregabalina e zonisamida sobre a produção, liberação e metabolismo dos hormônios tireoideanos (43). Em dois estudos clínicos, o uso de carbamazepina e oxcarbazepina associou-se à redução nos níveis de hormônios tireoideanos, que foram reversíveis com a suspensão das medicações (45,46). Há relatos em crianças de elevação do TSH (sem alterações nos níveis de T3 e T4) com uso crônico de valproato, mas esse quadro também é revertido com a supressão da droga (47,48).…”

Section: Dae E Função Tireoideanaunclassified

Efeitos endócrinos e metabólicos das drogas antiepilépticas

Bortolini

Kulak

Borba

et al. 2009

Arq Bras Endocrinol Metab

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RESUMOAs drogas antiepilépticas (DAE) são utilizadas por um enorme contingente de pessoas em todo o mundo -tanto no tratamento das epilepsias como para outros fins -frequentemente por um longo tempo. Por essas razões, torna-se fundamental o conhecimento sobre os potenciais efeitos adversos desses medicamentos, muitos deles envolvendo vários aspectos hormonais e metabólicos que devem ser do conhecimento do endocrinologista. Nesta revisão, foi abordada a relação das DAE com anormalidades no metabolismo mineral ósseo, balanço energético e peso corporal, eixo gonadal e função tireoideana, além de ter sido revisado o papel terapêutico dessas medicações no tratamento da neuropatia diabética. Arq Bras Endocrinol Metab. 2009;53(7):795-803.Descritores Drogas antiepilépticas; epilepsia; metabolismo mineral ósseo; obesidade; disfunção gonadal; disfunção tireoideana. ABSTRACTThe antiepileptic drugs (AED) have been widely used for a great deal of people -in the treatment of epilepsy and other diseases -throughout the world. Continuous and prolonged use of AED may be associated with adverse effects in different systems, including a variety of endocrine and metabolic abnormalities. In this review, the relationship of AED with alterations in bone mineral metabolism, energy balance and body weight, gonadal function and thyroid metabolism was revised, as well as their clinical utility in the treatment of diabetic neuropathy. INTRODUÇÃO A s drogas antiepilépticas (DAE) são utilizadas no tratamento da epilepsia desde 1857, quando Locock usou sal de brometo com resultados positivos em mulheres com epilepsia catamenial (1). Desde então, inúmeros medicamentos foram introduzidos na prática clínica para o tratamento dos mais diversos tipos de epilepsia, uma doença crônica comum que atinge homens e mulheres em todas as faixas etárias, com incidência anual de 43 casos por 100 mil habitantes em países indus trializados e o dobro em países em desenvolvimento (2). No Brasil, a prevalência encontrada tem variado de 0,4% a 0,8% da população (3). Além do clássico uso para tratamento da epilepsia, as várias ações das DAE resultaram em uma ampliação de seu uso terapêutico e, hoje, elas são empregadas tanto no controle de desordens psiquiátricas, como ansiedade, esquizofrenia e transtorno bipolar, como em distúrbios neurológicos diversos, incluin do tremor essencial, cefaleia e dores neuropáticas (4). Em caráter experimental, as DAE têm sido testadas em pacientes com câncer e infecção por HIV, no tratamento para o abuso de drogas e álcool e, também, como agentes neuroprotetores (4).Os principais mecanismos de ação das DAE mais utilizadas incluem bloqueio dos canais de sódio ou de cálcio dependentes de voltagem, aumento da inibição mediada por GABA e bloqueio ao glutamato (5). A fenitoína, o fenobarbital e a carbamazepina são metabolizados por via hepática por meio do citocromo P450 ("drogas indutoras hepáticas"), ao passo que a enzima hepática uridina difosfato glucuronosil transferase (UGP) é responsável pela metabolização do valproato

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Thyroid Function in Girls with Epilepsy with Carbamazepine, Oxcarbazepine, or Valproate Monotherapy and after Withdrawal of Medication

Cited by 114 publications

References 27 publications

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

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

Efeitos endócrinos e metabólicos das drogas antiepilépticas

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