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Thyroid function in children with epilepsy treated with sodium valproate monotherapy: a prospective study
Achilleas Attilakos1, Eustathia Katsarou, Alexia Prassouli
1Second Department of Pediatrics, University of Athens, Greece. attilakos@hotmail.com
Insights
Sodium valproate (VPA) monotherapy in children with epilepsy can alter thyroid hormone levels, decreasing thyroxine and increasing TSH. Monitoring thyroid function is recommended during VPA treatment.
Area of Science:
- Pediatric Endocrinology
- Neurology
- Clinical Pharmacology
Background:
- Epilepsy affects numerous children worldwide, with sodium valproate (VPA) being a common monotherapy.
- Previous studies on VPA's impact on thyroid function in epilepsy patients have yielded conflicting results.
- Understanding VPA's effects on thyroid hormone balance is crucial for managing pediatric epilepsy.
Purpose of the Study:
- To prospectively assess changes in thyroid hormone profiles in children with epilepsy receiving VPA monotherapy.
- To evaluate the temporal relationship between VPA treatment and thyroid function alterations.
- To determine if VPA monotherapy significantly impacts thyroxine, free thyroxine, triiodothyronine, and TSH levels.
Main Methods:
- Prospective evaluation of 30 children with epilepsy on VPA monotherapy.
- Measurement of serum thyroxine, free thyroxine, triiodothyronine, and TSH at baseline and at 6, 12, and 24 months.
- VPA serum concentrations were monitored to ensure they remained within the therapeutic range (50-100 mg/L).
Main Results:
- VPA monotherapy led to significant decreases in thyroxine and free thyroxine levels.
- Thyroid-stimulating hormone (TSH) levels significantly increased at 6, 12, and 24 months.
- Triiodothyronine levels showed a significant decrease only at 24 months, with a substantial percentage of children exhibiting elevated TSH.
- Thyroid function normalized in children after VPA withdrawal.
Conclusions:
- VPA monotherapy can induce significant thyroid profile alterations in children with epilepsy, appearing early and persisting during treatment.
- Routine monitoring of serum thyroid hormone concentrations is advisable for children with epilepsy on VPA.
- Further research is needed to elucidate the mechanisms and identify risk factors for VPA-induced thyroid disturbances in pediatric populations.
Objective:
Studies on the effects of sodium valproate (VPA) on thyroid hormone balance in patients with epilepsy are conflicting. The aim of this study was to prospectively evaluate the changes in thyroid profile in children with epilepsy treated with VPA monotherapy.
Methods:
Serum thyroxine, free thyroxine, triiodothyronine, and thyrotropin (TSH) levels were evaluated in 30 children with epilepsy, before and at 6, 12, and 24 months of VPA monotherapy.
Results:
All children had normal thyroid function before the initiation of VPA treatment. Serum VPA concentrations remained within the therapeutic range (50-100 mg/L) during the period of study. Thyroxine and free thyroxine levels were significantly decreased, whereas TSH levels were significantly increased at 6, 12, and 24 months of VPA therapy. Triiodothyronine levels were significantly decreased only at 24 months of therapy. Thirteen children (43.3%) at 6 months, 14 children (46.6%) at 12 months, and 15 children (50%) at 24 months of treatment had TSH values greater than 5 mIU/mL. Normal serum TSH levels were restored in all 8 children examined at 3 months after withdrawal of medication.
Conclusions:
Valproate monotherapy may cause significant alteration in thyroid profile in children with epilepsy, occurring early in the course of treatment and persisting as long as VPA is initiated. Therefore, it may be useful to measure serum thyroid hormone concentrations routinely in children with epilepsy taking VPA. Further prospective studies are required to determine the mechanisms and risk factors for development of thyroid disturbance in children treated with VPA monotherapy.
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