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Thyroid-function tests in diphenylhydantoin-treated patients.

M R Stjernholm, R N Alsever, M C Rudolph

    Clinical Chemistry
    |September 1, 1975
    PubMed
    Summary
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    Diphenylhydantoin medication may lower thyroid hormone levels, potentially affecting thyroid function tests. The free-thyroxine index may not accurately reflect thyroid status in patients taking this drug.

    Area of Science:

    • Endocrinology
    • Clinical Chemistry

    Background:

    • Thyroid hormone assays are crucial for diagnosing thyroid dysfunction.
    • Diphenylhydantoin (phenytoin) is a commonly prescribed anticonvulsant medication.
    • Potential drug interactions with thyroid function tests require careful consideration.

    Purpose of the Study:

    • To evaluate the impact of diphenylhydantoin on free-thyroxine index measurements.
    • To determine if diphenylhydantoin interferes with commonly used thyroid hormone assays.
    • To assess the validity of the free-thyroxine index in euthyroid patients on diphenylhydantoin therapy.

    Main Methods:

    • Comparison of free-thyroxine index in normal adults and euthyroid patients taking diphenylhydantoin.
    • Serum thyroxine and triiodothyronine uptake measured using two competitive protein-binding assays.

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  • Investigation of potential drug interference with assay methods.

    • Main Results:

    • Diphenylhydantoin therapy was associated with decreased mean serum thyroxine concentrations.
    • Triiodothyronine uptake remained unaffected by diphenylhydantoin.
    • A significant percentage of drug-treated patients exhibited subnormal free-thyroxine indexes.
    • Assay methodology did not show direct drug interference with thyroxine binding.

    Conclusions:

    • The free-thyroxine index may be reduced in patients taking diphenylhydantoin due to lower serum thyroxine levels.
    • The free-thyroxine index may not reliably estimate thyroid status or free thyroxine concentration in these patients.
    • Clinical interpretation of thyroid function tests in patients on diphenylhydantoin requires caution.