Valproate-induced Subclinical Hypothyroidism
Subscribe/Renew Journal
Introduction:
Sodium valproate (VPA) is widely used for the treatment of partial and generalized epilepsy in childhood and adolescence. The results of the studies that have evaluated the effect of VPA monotherapy on thyroid function in epileptic patients are controversial.
Objective:
Studies on the effects of sodium valproate 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 epilepsy treated with valproate monotherapy.
Methods:
Serum level of triiodothyronine (T3), thyroxin (T4) and thyroid stimulating hormone (TSH) were determined in 40 epileptic patients of valproate monotherapy by EIA method.
Results:
Epileptic patients had slightly decreased triiodothyronine (T3) and thyroxin (T4), whereas TSH level was significantly increased on valproate monotherapy.
Conclusion:
The results showed that valproate may induce subclinical hypothyroidism. This suggests a need for careful monitoring of serum TSH level in epileptic patients receiving valproate drug.
Keywords
- Fichsel H. Effect of anticonvulsant drug on thyroid hormone in epileptic patients. Epilepsia.1978; 19:323- 36.
- Liewendahl K, Majuri H. Thyroid function tests in patients on long term treatment with various anticonvulsant drugs. Clin Endocrinol Oxf, 1978; 8:185-91.
- Larkin JG, Macphee GJ. Thyroid hormone concentrations in epileptic patients. Eur J Clin Pharmacnl, 1989; 36:213- 216.
- Allison G. Some patients on epileptic drugs devlep thyroid abnormalities. American academy of neurology 62nd annual meeting poster PD2.007 Presented April 13, 2010.
- Toone BK, Edeh J. Hormone and behavioral changes in male epileptics. Advances epileptotogy: XV epilepsy international symposium New York: Raven Press 1984; 283- 289.
- Stjermholm MR. Thyroid function test in diphenylhydantoin treated patients. Clin Chem, 1975; 21:1388-1392.
- Isojarvi JIT. Thyroid function with antiepileptic drugs. Epilepsio, 1992; 3:142-148.
- Yuksel A, Kartal A. Serum thyroid hormone and pituitary response to thyrotropin releasing hormone in epileptic patients receiving antiepileptic medications. Ada. Paediatr Jpn, 1993; 35:108-112.
- Ericsson UB. Thyroblobuline and thyroid hormone in patients on long term treatment with anticonvulsant drugs. Epilepsia, 1985; 2:594-600.
- Deda G. Effect of anticonvulsant drugs on thyroid hormone in epileptic children. Turk J Pediatr, 1992; 34:239- 244.
- Sathyanaraynan U. Textbook of Biochemistry. Press book and allied private limited 1st Edition March 1999 revised edition.2001; 238-241.
- Juul-Jensen P. Prevalence of epilepsy. Stor Arhus Ugeskr Laeg, 1975; 137:2380-2388.
- Hauser WA. Epidemiology of epilepsy. Rochester, Minnesota, 1935 through 1967, Epilepsia16; 1-66.
- Reynolds EH. Iatrogenic disorders in epilepsy. In Williams (ed) Modern trends in neurology, Butterworth, London, 1970; 5:271-286.
- Hansen JM. The effect of phenytoin on thyroid hormone. Clin J Endcrinol Melah, 1974; 39:785-789.
- Rootwelt K. effect of anticonvulsant drugs on serum levels on thyroid hormone.Scanuj Clin Lab Invst, 1978; 38:731- 736.
- Alison P. Effect of treatment on endocrine function in patients with epilepsy. Current treatment option in neurology, 2005; 7:4.
- Isojrvi JIT. Serum hormones in male epileptic patients receiving anticonvulsant medication. Arch Nnirril, 1990; 47:670-676.
- Johannarattya R. The effect of anticonvulsant on growth and sexual maturation in girls with epilepsy. Pediatrics, 1999; 103:588-593.
- Berent S. Modern approaches to neuropsychological testing. Ailv Neural, 1991; 55:423-437.
- Connacher AA, Borsey DQ. The effective evaluation of thyroid status in patients on phenytoin, carbamazepine or sodium valproate attending as epilepsy clinic. Pediatrics international 2007; 49(6):822-826.
- Surks MI. Normal serum free thyroid hormone concentration in patients treated with anticonvulsant drugs. A paradox resolved JAMA, 1996; 275:1495-1498.
- Rootwelt K. Effect of anticonvulsant drugs on serum levels on thyroid hormones and thyrotropin in human. Scanu J Clin lab Invst, 1978; 38:731-736.
- Kazuhiro T, Soichi K. Thyroid function in children with long term anticonvulsant treatment. Pediatr Neuroscience, 1987; 13:90-94.
- Attilako A, Katsarou E. Thyroid function in children with epilepsy treated with sodium valproate monotherapy. Clin Neuropharmacol, 2009; 32(1):32-34.
- Achilleas A. Anastasia G. Thyroid function in epileptic patients treated with sodium valproate mono therapy. Postgrad Med J 1987; 63:841-845.
- Vainionpaa LK. Thyroid function in girls with epilepsy with anticonvulsant drugs and after withdrawal of medications. Epilepsia, 2004; 45(3):197-203.
- Díez JJ, Iglesias P: Spontaneous subclinical hypothyroidism in patients older than 55 years: an analysis of natural course and risk factors for the development of overt thyroid failure. J Clin Endocrinol Metab 2004; 89:4890– 4897.
- Eiris-Punal J, Del Rio-Garma M, Del Rio-Garma MC, et al: Long-term treatment of Children with epilepsy with valproate or carbamazepine may cause subclinical hypothyroidism. Epilepsia 1999; 40:1761–1766.
- Vainionpaa LK, Mikkonen K, Rattya J, et al: Thyroid function in girls with epilepsy with Carbamazepine, oxcarbazepine, or valproate monotherapy and after withdrawal of medication. Epilepsia 2004; 45:197–203.
- Isojarvi JI, Pakarinen AJ, Myllyla VV: Thyroid function with antiepileptic drugs. Epilepsia 1992; 33:142–148.
Abstract Views: 294
PDF Views: 0