EFFECT OF ANTIEPILEPTIC DRUGS ON THYROID HORMONE LEVELS IN CHILDREN WITH EPILEPSY
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Keywords
Antiepileptic Drugs, Thyroid Hormone, Children, Epilepsy
Abstract
Background: In this study, we wanted to evaluate the effect of antiepileptic drugs on thyroid hormone function in children with epilepsy, study and compare the thyroid status i.e. T3, T4, TSH of patients on various antiepileptics (phenytoin, carbamazepine, valproate etc.), assess the clinical findings in relation to their thyroid profile, and compare the effect of various AEDs on growth (i.e. weight and height) of subjects.
Methods: This was a hospital-based cross-sectional observational study conducted among 60 children between the age group of 2 months and 12 years with epilepsy, on antiepileptic drugs from 2019-2021, after obtaining clearance from institutional ethics committee and written informed consent from the study participants.
Results: Among the total 20 subjects on phenytoin, 45% of subjects showed low serum T3 levels, 10% of the subjects showed low T4 levels, 5% showed low TSH and 5% showed high TSH levels. Statistically significant result was seen (p=0.021) for phenytoin altering serum T4 levels. Among those on phenytoin, 10% showed low T4 levels and those without phenytoin had higher T4 levels. This finding was statistically significant that phenytoin lowers T4 levels. The drug carbamazepine had no effect on serum T3 levels, 50% subjects (n=1) showed high serum T4 levels. 50% cases showed low TSH levels, this result was statistically significant. Statistically significant results were obtained with occurrence of constipation with levetiracetam and carbamezepine, for levetiracetam (19%) and carbamazepine (50%), respectively. Lethargy as symptom of hypothyroidism was seen more commonly with phenobarbitone (20%), then followed by phenytoin (10%) and levetiracetam (9.5%). Among the 24 children with weight less than 3rd percentile, 58.3% (n=14) had deranged thyroid hormone levels. Among children with height less than 3rd percentile, 44.8% (n=13) had altered thyroid hormones levels. Analysis showed that these findings were statistically significant.
Conclusion: Routine investigation of thyroid hormone levels in children on AEDs can help us detect subclinical hypothyroidism. Ethnicity and genetic based follow-up studies on a larger population sample are essential.
References
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Dr. Juveria Fatima
Junior Consultant, Department of Paediatrics, Hope Children's Hospital, Hyderabad, Telangana, India.
Dr. Mounica Movva
Junior Consultant, Department of Paediatrics, Narmada Hospital, Hyderabad, Telangana, India.
Dr. A. Roja Rani
Junior Consultant, Department of Paediatrics, Kims Cuddles, Gachibowli, Hyderabad, Telangana, India.