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Thyroid hormones in children with epilepsy during long-term administration of carbamazepine and valproate

Department of Pediatrics, University of Chieti, Via dei Vestini 5, 66100 Chieti, Italy¹ Department of Child Neuropsychiatry, University of Bologna, Bologna, Italy

(Correspondence should be addressed to A Verrotti; Email: averrott{at}unich.it)

Objective: This study evaluates the effects of long-term carbamazepine (CBZ) and valproate acid (VPA) therapy on thyroid function in epileptic children.

Design: 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 (T₄), triiodothyronine (T₃), free thyroxine (fT₄), free triiodothyronine (fT₃), 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 T₄ and fT₄ levels significantly lower than baseline evaluation and control subjects. Serum T₄ and fT₄ concentrations were unaffected by VPA monotherapy. Serum T₃ and fT₃ 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.