Assessment of thyroid function among children with epilepsy receiving anticonvulsant monotherapy: a hospital based prospective study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20205503Keywords:
Antiepileptic drugs, Epilepsy, TSH, T4, T3Abstract
Background: Data on influence of antiepileptic drugs (AED) on thyroid profile in children is limited and is still controversial. This study aimed to investigate the effects of valproate, levetiracetam, phenobarbitone and oxcarbazepine monotherapy on thyroid function in children after one year of therapy.
Method: A total of 106 children (39 girls and 67 boys) with new onset and controlled epilepsy treated with valproate (n=52), phenobarbitone (n=12), oxcarbazepine (n=14) and levetiracetam (n=28) were enrolled in the study. Serum thyroxine (T4, T3) and thyroid-stimulating hormone (TSH) level were measured before and at one year of therapy.
Results: At baseline average T4, T3 and TSH concentrations were not different between the drug groups. Except levetiracetam all antiepileptics increased TSH after one year of therapy and there was significant difference in TSH increment in valproate treated patients compared to other anticonvulsants. All anti-epileptics except levetiracetam was found to decrease T4 and T3 after one year of therapy but there was no significant difference among the groups, unlike TSH. Sodium valproate was the most frequently used antiepileptic drug. None of children had any symptoms of hypothyroidism, only 3% had signs of hypothyroidism which included goitre on examination. Out of various seizure disorders generalised tonic clonic type was most common (47.5%) followed by atypical febrile seizure (23%).
Conclusions: All antiepileptic drugs studied except levetiracetam had varying degrees of deleterious effects on thyroid function.
References
Surks MI, Ortiz GH, Sawin CT. Subclinical thyroid disease: Scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.
Zulewski H, Müller B, Exer P, Miserez AR. Estimation of tissue hypothyroidism by a new clinical score: Evaluation of patients with various grades of hypothyroidism and controls. J Clin Endocrinol Metab. 1997;82:771-6.
Aijaz NJ, Flaherty EM, Preston T. Neurocognitive function in children with compensated hypothyroidism: lack of short-term effects on or off thyroxin. BMC Endocr Disord. 2006;6:2.
Verrotti A, Scardapane A, Manco R, Chiarelli F. Antiepileptic drugs and thyroid function. J Pediatric Endocrinol Metab. 2008;21:401-8.
Benedetti MS, Whomsley R, Baltes E, Tonner F. Alteration of thyroid hormone homeostasis by antiepileptic drugs in humans: involvement of glucuronosyltransferase induction. Eur J Clin Pharmacol. 2005;61:863-72.
Camfield P, Camfield C. Incidence, prevalence and etiology of seizures and epilepsy in children. Epileptic Disord. 2015;17(2):117-23.
Amani HA. Assessment of IQ in epileptic children and psychosocial impact on children and their families. MD Thesis. University of Khartoum, Sudan: 2003;47-57.
Khalid OA. Non febrile seizures in Sudanese children: MD Thesis. University of Khartoum, Sudan: 1994;44-87.
Murat T, Ozgun S, Sonmez MF, Aksoy A, Can G, Yavuzyilmaz A. Epilepsy Prevalence in the 0-17 Age Group in Trabzon, Turkey. Iran J Pediatr. 2012;22(3):344-50.
Rajendran N. Thyroid profile in children on anticonvulsant monotherapy. MD Thesis. The Tamil Nadu DR.M.G.R. Medical University. 2018;84.
Obeid SA. Effect of Antiepileptic Drugs on Thyroid Function in Epileptic Sudanese Children: MD Thesis. University of Khartoum. 2007;64-5.
Egunsola O, Choonara I, Sammons HM. Anti-epileptic drug utilization in pediatrics: a systematic review. BMJ Pediatri Open. 2017;1:e000088.
Svalheim S, Sveberg L, Mochol M, Tauboll E. Interactions between antiepileptic drugs and hormones. Seizure. 2015;12-7.
Mikati MA, Tarabay H, Khalil A, Rahi AC, El Banna D, Najjar S. Risk factors for development of subclinical hypothyroidism during valproic acid therapy. J Pediatric. 2007;151:178-81.
Lli CV, Bogićević D, Miljković B, Ješić M, Kovačević M, Prostran M et al. Duration of valproic acid monotherapy correlates with subclinical thyroid dysfunction in children with epilepsy. Epileptic Disord. 2016;18(2):181-6.
Yılmaz U, Yılmaz TS, Akıncı G, Tekgul H. The effect of antiepileptic drugs on thyroid function in children Seizure. 2014;23:29-35.
Verrotti A, Laus M, Scardapane A, Franzoni E, Chiarelli F. Thyroid hormones in children with epilepsy during long term administration of carbamazepine and valproate. Eur society Endocrinol. 2009;160:81-6.
Vainionpa LK, Mikkonen K, Rattya J, Knip M, Pakarinen AJ, Myllyla VV, et al. Thyroid function in girls with epilepsy with carbamazepine, oxcarbazepine, or valproate monotherapy and after withdrawal of medication. Epilepsia. 2004;45:197-203.
Prassouli A, Mastroyianni S. Thyroid function in children with epilepsy treated with sodium valproate monotherapy: a prospective study. Clin Neuropharmacol. 2009;32:32-4.
Dhodi DK, Bhagat SB, Patil KC. A comparative study of thyroid status of patients on phenytoin, carbamazepine and valproate monotherapy. Int J Basic Clin Pharmacol. 2016;5(2):362-5.
Durdane A, Solmaz V, Cevik B, Pekdas E, Kurt S. Serum Lipids and Thyroid Functions in Young Epileptic Patients Undergoing Monotherapy with Valproate or Levetiracetam. Eur J Gen Med. 2015;12(1):59-63.
Arrigo DF. Changes in thyroid function tests induced by 2-month carbamazepine treatment in L. Thyroxine substituted hypothyroid children. Eur J Pediatr. 1986;145(1-2):77-9.