Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate.
OBJECTIVE
This study evaluates the effects of long-term carbamazepine (CBZ) and valproate acid (VPA) therapy on thyroid function in epileptic children.


METHODS
A prospective study performed in 32 newly diagnosed pediatric patients, subdivided into two groups: 18 patients treated with CBZ and 14 patients treated with VPA. Thirty-two sex- and age- matched subjects served as controls.


METHODS
Serum TSH, thyroxine (T(4)), triiodothyronine (T(3)), free thyroxine (fT(4)), free triiodothyronine (fT(3)), thyroid peroxidase antibodies (TPO-Ab), and thyroglobulin antibodies (TG-Ab) were evaluated at baseline and at the 3rd, 6th, and 12th month in all patients and in the control group. A TRH stimulation test was performed in all epileptic patients at baseline and at the 3rd, 6th, and 12th month evaluations while in controls only baseline assessment was carried out.


RESULTS
At baseline evaluation, thyroid function was normal in all epileptic children. After 3 months, CBZ-treated patients showed serum T(4) and fT(4) levels significantly lower than baseline evaluation and control subjects. Serum T(4) and fT(4) concentrations were unaffected by VPA monotherapy. Serum T(3) and fT(3) were normal in both CBZ-treated and VPA-treated patients. TRH test was normal in all patients. At 6th and 12th month evaluations, the same alterations were present in CBZ-treated patients while thyroid function remained normal in VPA-treated patients. TRH test responses were normal in all epileptic patients. TPO-Ab and TG-Ab were always absent in all patients.


CONCLUSIONS
Our data suggest that VPA monotherapy does not alter thyroid hormones. On the contrary, alterations of thyroid hormones occur in CBZ-treated children. However, the patients are euthyroid and thyroid hormone alterations are not associated with clinical or subclinical hypothyroidism.
Verrotti
Alberto
A
Department of Pediatrics, University of Chieti, Chieti, Italy. averrott@unich.it
Laus
Melissa
M
Scardapane
Alessandra
A
Franzoni
Emilio
E
Chiarelli
Francesco
F
D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D002220:Carbamazepine / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D004334:Drug Administration Schedule; D004827:Epilepsy / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D013961:Thyroid Gland / Q000187:drug effects; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014635:Valproic Acid / Q000008:administration & dosage* / Q000009:adverse effects
D000927:Anticonvulsants; D013963:Thyroid Hormones; D014284:Triiodothyronine; D002220:Carbamazepine; D014635:Valproic Acid; D013972:Thyrotropin; D013974:Thyroxine