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Thyroid function in children with long-term anticonvulsant treatment
K Tanaka1, S Kodama, S Yokoyama
1Department of Pediatrics, Kobe University School of Medicine, Japan.
Insights
Long-term anticonvulsant use in children, including carbamazepine and phenobarbital, can negatively impact thyroid function, decreasing thyroid hormone levels. Regular thyroid function monitoring is recommended for these pediatric patients.
Area of Science:
- Pediatric Endocrinology
- Clinical Pharmacology
- Neurology
Background:
- Anticonvulsant medications are frequently prescribed for children with epilepsy and other neurological disorders.
- Long-term use of certain anticonvulsants may affect various endocrine functions, including thyroid regulation.
- Understanding these effects is crucial for comprehensive patient care and monitoring.
Purpose of the Study:
- To investigate the impact of long-term anticonvulsant therapy on thyroid function in a pediatric population.
- To assess the relationship between specific anticonvulsants (carbamazepine, phenobarbital, valproate) and thyroid hormone levels (T3, T4).
Main Methods:
- A cohort study involving 287 children receiving long-term anticonvulsant treatment.
- Analysis of serum concentrations of triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH).
- Correlation analysis between serum anticonvulsant levels and thyroid hormone levels.
Main Results:
- Carbamazepine (CBZ) treatment for over 3 years was associated with decreased serum T3 and T4, showing a negative correlation with CBZ levels.
- Phenobarbital (PB) treatment for over 6 years showed a trend towards decreased T3 and T4, though not statistically significant.
- Sodium valproate (VPA) did not show significant effects on T3 or T4 levels.
- Decreased free T4 and thyroxine-binding globulin, with increased TSH, were observed in patients with low serum T4.
Conclusions:
- Long-term anticonvulsant therapy, particularly with carbamazepine and phenobarbital, can alter thyroid function in children.
- Thyroid function monitoring is essential for pediatric patients undergoing extended anticonvulsant treatment.
- Further research may be warranted to elucidate the mechanisms and clinical significance of these thyroid function changes.
Abstract:
Thyroid functions were studied in 287 children given long-term treatment with anticonvulsants. Of these 287 patients, 26 were treated with carbamazepine (CBZ) alone, 63 with phenobarbital (PB) alone, 66 with sodium valproate (VPA) alone and 132 with combination therapy. Serum triiodothyronine (T3) and thyroxine (T4) concentrations were decreased after more than 3 years of treatment with CBZ. The regression line of serum T4 concentrations against serum CBZ concentrations indicated a negative correlation. Serum T3 and T4 concentrations were decreased after more than 6 years of treatment with PB, although there was no statistical significance in the relationship between serum T4 and PB concentrations. There was no significant decrease in serum T3 or T4 concentration in patients treated with VPA. Serum-free T4 and thyroxine-binding globulin were decreased and serum thyrotropic hormone concentration was increased in patients with low serum T4 concentrations. We conclude that thyroid functions should be examined in children given long-term treatment with anticonvulsants.