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The effect of antiepileptic drugs on thyroid function in children
Unsal Yılmaz1, Tuba Sevim Yılmaz2, Gülçin Akıncı1
1Department of Pediatric Neurology, Dr. Behçet Uz Children's Hospital, Izmir, Turkey.
Insights
Most antiepileptic drugs negatively impact children's thyroid function, except levetiracetam. This 12-month study monitored thyroid-stimulating hormone (TSH) and free thyroxine (fT4) in children treated with various antiepileptic drugs (AEDs).
Area of Science:
- Pediatric Endocrinology
- Clinical Pharmacology
- Neurology
Background:
- Limited data exists on how antiepileptic drugs (AEDs) affect thyroid function in pediatric populations.
- Conflicting evidence necessitates further investigation into the specific impacts of common AEDs.
Purpose of the Study:
- To evaluate the effects of monotherapy with phenobarbital, valproate, carbamazepine, oxcarbazepine, and levetiracetam on thyroid function in children.
- To assess thyroid-stimulating hormone (TSH) and free thyroxine (fT4) levels over a 12-month period in daily clinical practice.
Main Methods:
- A prospective study involving 223 children with new-onset epilepsy.
- Patients were treated with valproate (n=129), phenobarbital (n=33), carbamazepine (n=36), oxcarbazepine (n=14), or levetiracetam (n=11).
- Serum fT4 and TSH levels were measured at baseline and at 1, 6, and 12 months of therapy.
Main Results:
- Valproate, carbamazepine, phenobarbital, and oxcarbazepine showed significant decreases in fT4 and/or increases in TSH levels over 12 months.
- Levetiracetam monotherapy did not result in significant changes in fT4 or TSH levels.
- At 12 months, subclinical hypothyroidism frequencies were 28% (valproate), 21.4% (oxcarbazepine), 18.2% (phenobarbital), 13.9% (carbamazepine), and 0% (levetiracetam).
Conclusions:
- AEDs including valproate, carbamazepine, phenobarbital, and oxcarbazepine have varying adverse effects on pediatric thyroid function.
- Levetiracetam appears to be a safer alternative regarding thyroid function in children.
- Regular monitoring of thyroid function is recommended for children on these AEDs, particularly valproate.
Background:
Limited and conflicting data exist for the influence of antiepileptic drugs on thyroid function in children.
Objective:
The aim of this study was to investigate the effects of phenobarbital, valproate, carbamazepine, oxcarbazepine, and levetiracetam monotherapy on thyroid function in daily clinical practice during a 12-month treatment period.
Method:
A total of 223 children (103 females and 120 males) with new onset and controlled epilepsy treated with valproate (n=129), phenobarbital (n=33), carbamazepine (n=36), oxcarbazepine (n=14), levetiracetam (n=11) were enrolled in the study. Serum free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels were measured before and at first, sixth and twelfth months of therapy.
Results:
At baseline, average fT4 and TSH concentrations were not different between the drug groups. Valproate-treated patients had decreased fT4 and increased TSH levels at months 1, 6, and 12. Carbamazepine-treated patients had decreased fT4 levels at months 1, 6, and 12 and increased TSH levels at months 1, and 6. Phenobarbital-treated patients had decreased fT4 levels at months 1, and 6, and increased TSH levels at months 6 and 12. Oxcarbazepine-treated patients had decreased fT4 levels at month 1. Levetiracetam-treated patients showed no significant change of fT4 and TSH at any times. The frequency of subclinical hypothyroidism at month 12 was 28% in valproate, 21.4% in oxcarbazepine, 18.2% in phenobarbital, 13.9% in carbamazepine, and 0% in levetiracetam groups.
Conclusion:
Our data suggest that all antiepileptic drugs studied except levetiracetam had varying degrees of deleterious effects on thyroid function.
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